Healthcare Provider Details

I. General information

NPI: 1437049574
Provider Name (Legal Business Name): SHANNON BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WINSTON PL
WILMINGTON DE
19804-1849
US

IV. Provider business mailing address

206 WINSTON PL
WILMINGTON DE
19804-1849
US

V. Phone/Fax

Practice location:
  • Phone: 302-553-6767
  • Fax:
Mailing address:
  • Phone: 302-553-6767
  • Fax: 302-553-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012966
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: