| Doctor Name: | SHANDA BERDAN |
| NPI Number: | 1407252133 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6401013102 |
| Business Practice Address: | 337 E Houghton Ave Clinic A West Branch, MI - 486611127 |
| Business Phone Number: | 9897015836 |
| Business Fax Number: | 9896858363 |
| Mailing Address: | Po Box 325, 216 Hebestreit St. ROSE CITY |
| State: | MI |
| Postal Code: | 486540325 |
| Phone Number: | 9897015836 |
| Fax Number: | 9896858363 |
| NPI Enumeration Date: | 11/06/2014 |
| NPI Last Update Date: | 11/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401013102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |