Provider Demographics
NPI:1538393194
Name:BRADSHAW, JOANIE GARCIA (PA)
Entity type:Individual
Prefix:
First Name:JOANIE
Middle Name:GARCIA
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CORLIES AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1904
Mailing Address - Country:US
Mailing Address - Phone:646-844-9602
Mailing Address - Fax:646-846-2310
Practice Address - Street 1:779 NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-3105
Practice Address - Country:US
Practice Address - Phone:646-844-9602
Practice Address - Fax:646-846-2310
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant