Provider Demographics
NPI:1700418498
Name:BROWN-HEARD, SHELIA
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:
Last Name:BROWN-HEARD
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 1:6485 CHEYENNE PKWY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-8626
Mailing Address - Country:US
Mailing Address - Phone:251-298-3553
Mailing Address - Fax:
Practice Address - Street 1:3104 BLUE LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2372
Practice Address - Country:US
Practice Address - Phone:205-915-6284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0300524363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health