Provider Demographics
NPI:1326911876
Name:SHORTNACY, BRANDON JAMES (RADT1)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:SHORTNACY
Suffix:
Gender:M
Credentials:RADT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 E SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-7220
Mailing Address - Country:US
Mailing Address - Phone:559-371-2546
Mailing Address - Fax:559-258-0249
Practice Address - Street 1:4576 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-7220
Practice Address - Country:US
Practice Address - Phone:559-371-2546
Practice Address - Fax:559-258-0249
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1620040725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)