Provider Demographics
NPI:1659086551
Name:BROWN, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 STONEHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1240
Mailing Address - Country:US
Mailing Address - Phone:234-380-2954
Mailing Address - Fax:
Practice Address - Street 1:787 STONEHAVEN CIR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1240
Practice Address - Country:US
Practice Address - Phone:234-380-2954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion