Provider Demographics
NPI:1962043646
Name:BROWN, SANDRIA DENISE
Entity Type:Individual
Prefix:
First Name:SANDRIA
Middle Name:DENISE
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 1:3518 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4114
Mailing Address - Country:US
Mailing Address - Phone:419-724-4973
Mailing Address - Fax:419-724-4974
Practice Address - Street 1:3518 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4114
Practice Address - Country:US
Practice Address - Phone:419-724-4973
Practice Address - Fax:419-724-4974
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator