Provider Demographics
NPI:1497419980
Name:ROBINSON, SHANDA S
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:S
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANDA
Other - Middle Name:S
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8013 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3510
Mailing Address - Country:US
Mailing Address - Phone:215-407-0587
Mailing Address - Fax:
Practice Address - Street 1:8013 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3510
Practice Address - Country:US
Practice Address - Phone:215-407-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty