Provider Demographics
NPI:1336548270
Name:STALEY SHUMAKER, BRIANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:STALEY SHUMAKER
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 1:3445 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3716
Mailing Address - Country:US
Mailing Address - Phone:805-941-0838
Mailing Address - Fax:
Practice Address - Street 1:10475 CROSSPOINT BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3386
Practice Address - Country:US
Practice Address - Phone:805-941-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34123103TC0700X
WA60931917103TC0700X
IN20043657A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical