SHADISHA K BENNETT BRODDE LPC NPI 1477826022

NPI Information

  • NPI: 1477826022
  • Provider Name: SHADISHA K BENNETT BRODDE, LPC
  • Classification: Counselor - 101YM0800X
  • Specialization: Mental Health
  • Entity Type: Individual
  • Address: 910 GOLDEN LAKE LOOP
    SAINT AUGUSTINE, FL
    ZIP 32084
  • Phone: (478) 387-5582

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NPI Details

Shadisha K Bennett Brodde, LPC is a mental health counselor in Saint Augustine, FL. Shadisha K Bennett Brodde, LPC NPI is 1477826022. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

910 GOLDEN LAKE LOOP
SAINT AUGUSTINE, FL
ZIP 32084-877
Phone: (478) 387-5582

The enumeration date for this NPI number is 2/13/2012 and was last updated on 6/16/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental HealthMH18303FLORIDAYes
2101YP2500XCounselorProfessional178005880ILLINOISNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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