Provider Demographics
NPI:1942794698
Name:BROWN, DESLINE
Entity Type:Individual
Prefix:
First Name:DESLINE
Middle Name:
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 1:6 ADRIAN CT
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4145
Mailing Address - Country:US
Mailing Address - Phone:347-205-3986
Mailing Address - Fax:914-402-4165
Practice Address - Street 1:6 ADRIAN CT
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4145
Practice Address - Country:US
Practice Address - Phone:347-205-3986
Practice Address - Fax:914-402-4165
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency