MEDICARE: MS. SHARYN KIZIAH BRADY MA, LPC

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	101YS0200X	School Counselor	4757	NC

General Provider Information

NPI Number	:	1750555645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARYN KIZIAH BRADY MA, LPC

Provider Business Mailing Address
First Line	:	3695 E BURKE BLVD
Second Line	:
City	:	CONNELLYS SPRINGS
State	:	NC
Zip	:	28612-7594
Country	:	US
Telephone Number	:	828-397-1725
Fax Number	:	828-397-7652

Provider Business Practice Location Address
First Line	:	3695 E BURKE BLVD
Second Line	:
City	:	CONNELLYS SPRINGS
State	:	NC
Zip	:	28612-7594
Country	:	US
Telephone Number	:	828-397-1725
Fax Number	:	828-397-7652

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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