Provider Demographics
NPI:1548541048
Name:HEUN, SHANNA BROOKE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:BROOKE
Last Name:HEUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHANNA
Other - Middle Name:BROOKE
Other - Last Name:DULEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:912 CHANNELSIDE DRIVE 2414
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602
Mailing Address - Country:US
Mailing Address - Phone:585-507-1508
Mailing Address - Fax:
Practice Address - Street 1:501 S SHARON AMITY RD STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3099
Practice Address - Country:US
Practice Address - Phone:704-802-5468
Practice Address - Fax:704-800-5768
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8953103TC1900X
NC5173103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548541048Other103TC1900X