Provider Demographics
NPI:1598769051
Name:BROWN, SHARON D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W DOROTHY LN
Mailing Address - Street 2:STE 104
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1327
Mailing Address - Country:US
Mailing Address - Phone:937-294-6612
Mailing Address - Fax:937-236-0661
Practice Address - Street 1:1250 W DOROTHY LN
Practice Address - Street 2:STE 104
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1327
Practice Address - Country:US
Practice Address - Phone:937-294-6612
Practice Address - Fax:937-236-0661
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-11
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBRCP16233Medicare ID - Type Unspecified