Provider Demographics
NPI:1518501485
Name:BROWN, SHANNON (RPSGT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5502
Mailing Address - Country:US
Mailing Address - Phone:516-465-8270
Mailing Address - Fax:516-465-8274
Practice Address - Street 1:410 LAKEVILLE RD STE 107
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1102
Practice Address - Country:US
Practice Address - Phone:516-465-5346
Practice Address - Fax:516-465-5454
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
NY000451225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No174H00000XOther Service ProvidersHealth Educator