Provider Demographics
NPI:1861187171
Name:SHAFFER-KUNES, BRIANNA CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:CHRISTINE
Last Name:SHAFFER-KUNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:CHRISTINE
Other - Last Name:KUNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-4200
Mailing Address - Fax:814-375-4232
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-299-7420
Practice Address - Fax:814-372-2573
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT228463390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104288496Medicaid