Provider Demographics
NPI:1528237112
Name:BRYANT, SHAWN WADE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:WADE
Last Name:BRYANT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 W. COURT ST.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310
Mailing Address - Country:US
Mailing Address - Phone:402-228-6446
Mailing Address - Fax:402-228-0394
Practice Address - Street 1:839 W. COURT ST.
Practice Address - Street 2:SUITE 4
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310
Practice Address - Country:US
Practice Address - Phone:402-228-6446
Practice Address - Fax:402-228-0394
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELP0549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical