Basic Information
| Provider Information | |||||||||
| NPI: | 1205859394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAMIS | ||||||||
| FirstName: | BRAD | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4802 NESHAMINY BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190201041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157522287 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4802 NESHAMINY BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190201041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157522287 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS005689L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.