Provider Demographics
NPI:1497113658
Name:BROWN, SHAVONNE
Entity Type:Individual
Prefix:MS
First Name:SHAVONNE
Middle Name:
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 1:4320 W BROWARD BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3756
Mailing Address - Country:US
Mailing Address - Phone:954-266-9013
Mailing Address - Fax:786-257-5686
Practice Address - Street 1:4320 W BROWARD BLVD
Practice Address - Street 2:STE 4
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3756
Practice Address - Country:US
Practice Address - Phone:954-266-9013
Practice Address - Fax:855-941-2537
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7457235Z00000X
FLSA15362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016647600Medicaid