Healthcare Provider Details

I. General information

NPI: 1720783178
Provider Name (Legal Business Name): BREA AUTUMN SHUE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 06/22/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 HARRISBURG AVE
LANCASTER PA
17603-2827
US

IV. Provider business mailing address

2155 STRICKHOUSER RD
SEVEN VALLEYS PA
17360-8657
US

V. Phone/Fax

Practice location:
  • Phone: 717-740-4100
  • Fax:
Mailing address:
  • Phone: 717-600-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP026847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: