Provider Demographics
NPI:1205859394
Name:SHAMIS, BRAD (PHD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:SHAMIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 NESHAMINY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1041
Mailing Address - Country:US
Mailing Address - Phone:215-752-2287
Mailing Address - Fax:
Practice Address - Street 1:4802 NESHAMINY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1041
Practice Address - Country:US
Practice Address - Phone:215-752-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005689L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2347611000Medicare UPIN
PA617794T19Medicare ID - Type Unspecified