MEDICARE: SHEVENE BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4557	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134146707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEVENE BRYANT

Provider Business Mailing Address
First Line	:	315 WENTWORTH CIR
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302-7191
Country	:	US
Telephone Number	:	336-229-5905
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S MAIN ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5756
Country	:	US
Telephone Number	:	336-229-5905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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Directions to “ SHEVENE BRYANT ” Practice Location

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