Healthcare Provider Details

I. General information

NPI: 1699687590
Provider Name (Legal Business Name): JULIANA SHEA BRODER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BRANDON AVE
OPP AL
36467-3701
US

IV. Provider business mailing address

209 BRANDON AVE
OPP AL
36467-3701
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-4007
  • Fax: 334-699-4014
Mailing address:
  • Phone: 334-699-4007
  • Fax: 334-699-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: