Healthcare Provider Details

I. General information

NPI: 1275955031
Provider Name (Legal Business Name): SHABNAM BRADY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CHARLOTTE AVE
NASHVILLE TN
37209-3936
US

IV. Provider business mailing address

3501 CHARLOTTE AVE
NASHVILLE TN
37209-3936
US

V. Phone/Fax

Practice location:
  • Phone: 615-988-7541
  • Fax:
Mailing address:
  • Phone: 615-988-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: