Provider Demographics
NPI:1649360587
Name:BRENT, SHAWNA S (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:S
Last Name:BRENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 ERFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1163
Mailing Address - Country:US
Mailing Address - Phone:717-730-8555
Mailing Address - Fax:717-730-4566
Practice Address - Street 1:20 ERFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1163
Practice Address - Country:US
Practice Address - Phone:717-730-8555
Practice Address - Fax:717-730-4566
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-065197-L2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G85057 019158Medicare ID - Type Unspecified
G85057Medicare UPIN