Provider Demographics
NPI:1811626732
Name:DUNHAM, SHABRERICYSHA CHANAY
Entity Type:Individual
Prefix:
First Name:SHABRERICYSHA
Middle Name:CHANAY
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREE
Other - Middle Name:SHANE
Other - Last Name:BROADWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1908A PEPPERTREE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2192
Mailing Address - Country:US
Mailing Address - Phone:612-387-5184
Mailing Address - Fax:
Practice Address - Street 1:1822 E NC-54
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-474-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor