MEDICARE: BRANDON KEITH SHEARD LAC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487473138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON KEITH SHEARD LAC

Provider Business Mailing Address
First Line	:	151 N 5TH AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-7201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 N 5TH AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-7201
Country	:	US
Telephone Number	:	732-272-4781
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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Directions to “ BRANDON KEITH SHEARD LAC” Practice Location

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