| Doctor Name: | SHAWN RICHARD BRADY |
| NPI Number: | 1639482573 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 2417 |
| Business Practice Address: | 201 Chestnut Hill Rd Stafford Springs, CT - 060764005 |
| Business Phone Number: | 8606848126 |
| Business Fax Number: | |
| Mailing Address: | 72 Kingfisher Cir, SOUTH WINDSOR |
| State: | CT |
| Postal Code: | 060744307 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/21/2010 |
| NPI Last Update Date: | 07/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2417 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |