Provider Demographics
NPI:1609910108
Name:BROWN, SHAWN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WADDY
Mailing Address - State:KY
Mailing Address - Zip Code:40076-6107
Mailing Address - Country:US
Mailing Address - Phone:502-682-4808
Mailing Address - Fax:
Practice Address - Street 1:3070 PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:WADDY
Practice Address - State:KY
Practice Address - Zip Code:40076-6107
Practice Address - Country:US
Practice Address - Phone:502-682-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY425272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100075830Medicaid
KY0768220Medicare UPIN