Healthcare Provider Details

I. General information

NPI: 1578299533
Provider Name (Legal Business Name): BRANDI SHAY CECIL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2022
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 N MICHIGAN RD STE 240
ZIONSVILLE IN
46077-7845
US

IV. Provider business mailing address

10801 N MICHIGAN RD STE 240
ZIONSVILLE IN
46077-7845
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 502-460-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1161738
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71015572A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: