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General NPI Number Information
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NPI Number | 1467762187
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Entity Type | Individual
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Provider Name | SHANNON BRANLUND PHD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 361 ISRG BLDG #90760 ROOM #106
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City | HURLBURT FIELD
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State | FL
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Zip | 32544
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Country | US
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Telephone | 850-884-1348
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 ZEMKE AVE
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City | TAMPA
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State | FL
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Zip | 33621-5023
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Country | US
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Telephone | 813-827-9170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1850
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1850
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License Number State | AL
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