Provider Demographics
NPI:1851496822
Name:DR. BRAD SHAMIS & ASSOCIATES, LLC
Entity type:Organization
Organization Name:DR. BRAD SHAMIS & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNUNZIATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-223-1945
Mailing Address - Street 1:7028 E THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4049
Mailing Address - Country:US
Mailing Address - Phone:215-752-2287
Mailing Address - Fax:215-322-6067
Practice Address - Street 1:7010 E ACOMA DR STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3550
Practice Address - Country:US
Practice Address - Phone:215-752-2287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005689L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089367Medicare ID - Type Unspecified