MEDICARE: DR. JEANNIE SHAYNA BROOKS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	017781	NY
2	282N00000X	General Acute Care Hospital	017781	NY
3	103TC0700X	Clinical Psychologist	7961	FL
4	103TF0200X	Forensic Psychologist	7961	FL
5	103TB0200X	Cognitive & Behavioral Psychologist	7961	FL
6	103TC2200X	Clinical Child & Adolescent Psychologist	7961	FL

General Provider Information

NPI Number	:	1366648370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNIE SHAYNA BROOKS PSYD

Provider Business Mailing Address
First Line	:	1850 HOMEWOOD BLVD
Second Line	:	#217
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6918
Country	:	US
Telephone Number	:	954-854-6145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 HOMEWOOD BLVD APT 217
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6894
Country	:	US
Telephone Number	:	954-854-6145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	04/20/2010

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