Provider Demographics
NPI:1609101385
Name:WEEDEN, SHANDA
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BLAKE CT
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3009
Mailing Address - Country:US
Mailing Address - Phone:412-538-8745
Mailing Address - Fax:
Practice Address - Street 1:1150 FIRST AVE # 551
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1334
Practice Address - Country:US
Practice Address - Phone:412-538-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005097101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor