Provider Demographics
NPI:1457243834
Name:SHIDLER, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:SHIDLER
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 1:11211 N COUNTY ROAD 625 W
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46175-9001
Mailing Address - Country:US
Mailing Address - Phone:574-808-9524
Mailing Address - Fax:
Practice Address - Street 1:11211 N COUNTY ROAD 625 W
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46175-9001
Practice Address - Country:US
Practice Address - Phone:574-808-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator