Provider Demographics
NPI:1760928519
Name:BRANYON, SHARNELLE (LADC)
Entity Type:Individual
Prefix:MS
First Name:SHARNELLE
Middle Name:
Last Name:BRANYON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BLUE HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2924
Mailing Address - Country:US
Mailing Address - Phone:203-503-1468
Mailing Address - Fax:
Practice Address - Street 1:6 EDGERLY PL FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5327
Practice Address - Country:US
Practice Address - Phone:617-861-0370
Practice Address - Fax:617-249-1937
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008022622Medicaid
CT008001325Medicaid
CT004082260Medicaid