Provider Demographics
NPI:1023506896
Name:HYDE, SHAUNA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MISSOURI RUN RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-8329
Mailing Address - Country:US
Mailing Address - Phone:304-588-1470
Mailing Address - Fax:
Practice Address - Street 1:1400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3427
Practice Address - Country:US
Practice Address - Phone:304-588-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15835101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral