Provider Demographics
NPI:1740016815
Name:SHIVERDECKER, BRANDI SUZANNE (CPRC-A)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUZANNE
Last Name:SHIVERDECKER
Suffix:
Gender:F
Credentials:CPRC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 N STATE ROAD 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47327-9436
Mailing Address - Country:US
Mailing Address - Phone:765-478-5411
Mailing Address - Fax:
Practice Address - Street 1:2060 N STATE ROAD 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-9436
Practice Address - Country:US
Practice Address - Phone:765-478-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN175T00000X
INCAPRC1-6134175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist