Shada, Kiryl N

Shada, Kiryl N is an sole proprietor health care provider with primary practice located at 12500 Aurora Dr , Pleasant Prairie WI 53158-1227. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Shada, Kiryl N can be contacted via phone (262) 857-5000.

Contact Information

Primary practice address
12500 Aurora Dr Pleasant Prairie WI 53158-1227
Phone: (262) 857-5000
Fax: (262) 857-5001
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Psychologist 103T00000X 22780 Wisconsin

Profile Details

NPI number 1841667797
LBN Legal business name Shada, Kiryl N
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 26th, 2015
Last updated Nov 16th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841667797 NPPES
Wisconsin MEDICAID 100209168

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