Healthcare Provider Details

I. General information

NPI: 1750762092
Provider Name (Legal Business Name): BRIGETTE SHY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6149 OLDE EIGHT RD
BOSTON HEIGHTS OH
44264-9743
US

IV. Provider business mailing address

6149 OLDE EIGHT RD
BOSTON HEIGHTS OH
44264-9743
US

V. Phone/Fax

Practice location:
  • Phone: 330-671-7213
  • Fax:
Mailing address:
  • Phone: 330-671-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7290
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: