Sharde Bryaun Pettis, M.A.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

2825 Burnet Ave FL 4
Cincinnati, OH 45219-2426

Phone

(513) 558-5857

NPI assigned

Jul 1, 2018

Reactivated

Apr 29, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Hospital

  • Children's Hospital
  • Washington, DC
  • NPI 1912939703
  Medicare reassignment NPD
• Children'S Hospital

  • Community/Retail Pharmacy
  • Silver Spring, MD
  • NPI 1326878349
  NPD
• Children'S Hospital

  • Pediatrics Physician
  • Washington, DC
  • NPI 1780800128
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1578058608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 BURNET AVE FL 4",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192426",
            "telephone_number": "513-558-5857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 BURNET AVE FL 4",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192426",
            "telephone_number": "513-558-5857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "SHARDE",
        "middle_name": "BRYAUN",
        "name_prefix": "Ms.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-01",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "deactivation_date": "2020-04-02",
        "reactivation_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Charles Pettigrew, MD
• Keisha Pettijohn
• Precious Pettijohn
• Amanda Pettis, M.A., CCC-A
• Michaela E Pettis
• Chappel Cronier Pettit, MD
• Cynthia Sue Pettit, CRNP MSN
• Jakiesha Pettway, REV
• Ladenia Kiona Pettway, RN
• Heather Marie Petty, PHARMD

• Clinical Child & Adolescent Psychologist in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Clinical Child & Adolescent Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.