Provider Demographics
NPI:1891508552
Name:BREED, SHENIKA LANEE
Entity type:Individual
Prefix:
First Name:SHENIKA
Middle Name:LANEE
Last Name:BREED
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 1:3216 STEGNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2215
Mailing Address - Country:US
Mailing Address - Phone:502-599-1440
Mailing Address - Fax:
Practice Address - Street 1:3216 STEGNER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2215
Practice Address - Country:US
Practice Address - Phone:502-599-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
294941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist