Basic Information
| Provider Information | |||||||||
| NPI: | 1851496822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. BRAD SHAMIS & ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4802 NESHAMINY BLVD STE 6 | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190201041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157522287 | ||||||||
| FaxNumber: | 2153226067 | ||||||||
| Practice Location | |||||||||
| Address1: | 4802 NESHAMINY BLVD STE 6 | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190201041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157522287 | ||||||||
| FaxNumber: | 2153226067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2153224720 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS005689L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.