Provider Demographics
NPI:1811870330
Name:BERRY, SHANDA J
Entity type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:J
Last Name:BERRY
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 1:321 HERBERTSVILLE RD
Mailing Address - Street 2:BASEMENT SUITE
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:848-241-3907
Mailing Address - Fax:848-241-3731
Practice Address - Street 1:321 HERBERTSVILLE RD
Practice Address - Street 2:BASEMENT SUITE
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:848-241-3907
Practice Address - Fax:848-241-3731
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant