Provider Demographics
NPI:1679040521
Name:BROWN, SHANIKA RENEE
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:RENEE
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 1:4940 MACK RD APT 466
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4567
Mailing Address - Country:US
Mailing Address - Phone:916-226-0808
Mailing Address - Fax:
Practice Address - Street 1:4940 MACK RD APT 466
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4567
Practice Address - Country:US
Practice Address - Phone:916-226-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty