Provider Demographics
NPI:1740884097
Name:BROWN, SHADONNA D
Entity type:Individual
Prefix:
First Name:SHADONNA
Middle Name:D
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 1:4676 PRINCESS ANNE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6468
Mailing Address - Country:US
Mailing Address - Phone:757-937-9084
Mailing Address - Fax:
Practice Address - Street 1:4676 PRINCESS ANNE RD STE 130
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6468
Practice Address - Country:US
Practice Address - Phone:757-937-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist