Provider Demographics
NPI:1255148078
Name:PHILLIPS, SHANYE A (PHD, NCSP)
Entity type:Individual
Prefix:DR
First Name:SHANYE
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SAINT DAVID CT APT X1
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3294
Mailing Address - Country:US
Mailing Address - Phone:215-694-4158
Mailing Address - Fax:
Practice Address - Street 1:232 SAINT DAVID CT APT X1
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3294
Practice Address - Country:US
Practice Address - Phone:215-694-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool