Healthcare Provider Details

I. General information

NPI: 1548541048
Provider Name (Legal Business Name): SHANNA BROOKE HEUN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNA BROOKE DULEN PHD

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 11/27/2023
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SHARON AMITY RD STE 350
CHARLOTTE NC
28211-3099
US

IV. Provider business mailing address

912 CHANNELSIDE DRIVE 2414
TAMPA FL
33602
US

V. Phone/Fax

Practice location:
  • Phone: 704-802-5468
  • Fax: 704-800-5768
Mailing address:
  • Phone: 585-507-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 8953
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5173
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: