Provider Demographics
NPI:1235800806
Name:BROWN, SHETANQUA CARDIAYE
Entity Type:Individual
Prefix:MS
First Name:SHETANQUA
Middle Name:CARDIAYE
Last Name: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 1:1917 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8532
Mailing Address - Country:US
Mailing Address - Phone:318-235-1487
Mailing Address - Fax:
Practice Address - Street 1:1917 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-8532
Practice Address - Country:US
Practice Address - Phone:318-235-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health