Provider Demographics
NPI:1346909223
Name:ANDERSON, SHANADA YJAN (MS)
Entity Type:Individual
Prefix:MS
First Name:SHANADA
Middle Name:YJAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 CEDAR AVE # A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1620
Mailing Address - Country:US
Mailing Address - Phone:215-840-6596
Mailing Address - Fax:
Practice Address - Street 1:5003 CEDAR AVE # A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1620
Practice Address - Country:US
Practice Address - Phone:215-840-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health