Provider Demographics
NPI:1184156101
Name:BROWN, SHAWN DEE (CPO)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:DEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:MR
Other - First Name:SHAWN
Other - Middle Name:DEE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPO
Mailing Address - Street 1:2410 N GLENDALE DR STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-8909
Mailing Address - Country:US
Mailing Address - Phone:260-312-1746
Mailing Address - Fax:
Practice Address - Street 1:2410 N GLENDALE DR STE C
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-8909
Practice Address - Country:US
Practice Address - Phone:260-312-1746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier