Provider Demographics
NPI:1922739085
Name:DUDLEY-COLLINS, SHEENA LYNN
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:LYNN
Last Name:DUDLEY-COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BENT CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1938
Mailing Address - Country:US
Mailing Address - Phone:717-628-3783
Mailing Address - Fax:
Practice Address - Street 1:200 BENT CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1938
Practice Address - Country:US
Practice Address - Phone:717-628-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty