Provider Demographics
NPI:1700225851
Name:GASKIN-BROWN, SHORHONDA MARIE
Entity Type:Individual
Prefix:
First Name:SHORHONDA
Middle Name:MARIE
Last Name:GASKIN-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 1:65 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:HEMINGWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29554-6017
Mailing Address - Country:US
Mailing Address - Phone:843-933-5651
Mailing Address - Fax:
Practice Address - Street 1:65 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:HEMINGWAY
Practice Address - State:SC
Practice Address - Zip Code:29554-6017
Practice Address - Country:US
Practice Address - Phone:843-933-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC201708163WC1500X, 175L00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No175L00000XOther Service ProvidersHomeopath
No302R00000XManaged Care OrganizationsHealth Maintenance Organization