Provider Demographics
NPI:1740603984
Name:BROWN, SHELBY S
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:S
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 1:13181 LAKESHORE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5459
Mailing Address - Country:US
Mailing Address - Phone:407-257-5521
Mailing Address - Fax:
Practice Address - Street 1:13181 LAKESHORE GROVE DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5459
Practice Address - Country:US
Practice Address - Phone:407-257-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant