Provider Demographics
NPI:1114275005
Name:OSLEY-BROWN, CHANELLE
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:
Last Name:OSLEY-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 BERMUDA LAKE DR
Mailing Address - Street 2:APT. 202B
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2489
Mailing Address - Country:US
Mailing Address - Phone:813-546-2608
Mailing Address - Fax:813-490-5495
Practice Address - Street 1:2642 BERMUDA LAKE DR
Practice Address - Street 2:APT. 202B
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2489
Practice Address - Country:US
Practice Address - Phone:813-546-2608
Practice Address - Fax:813-490-5495
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator