Provider Demographics
NPI:1669789459
Name:HERNANDEZ, SHADY (MA)
Entity type:Individual
Prefix:
First Name:SHADY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHADY
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, HS-BCP
Mailing Address - Street 1:301 S PERIMETER PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4128
Mailing Address - Country:US
Mailing Address - Phone:423-503-6332
Mailing Address - Fax:877-706-1692
Practice Address - Street 1:301 S PERIMETER PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4128
Practice Address - Country:US
Practice Address - Phone:423-503-6332
Practice Address - Fax:877-706-1692
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor