Provider Demographics
NPI:1548746365
Name:BRINO, KASSONDRA AMADA SHOEMAKER (DNP, CPNP, PMHNP)
Entity type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:AMADA SHOEMAKER
Last Name:BRINO
Suffix:
Gender:F
Credentials:DNP, CPNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SILVER PINE CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9266
Mailing Address - Country:US
Mailing Address - Phone:919-627-8771
Mailing Address - Fax:
Practice Address - Street 1:100 W H ST
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1605
Practice Address - Country:US
Practice Address - Phone:919-338-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010693363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC68535Medicaid