Provider Demographics
NPI:1801065685
Name:BROWN, NEFERTITI ADUNNI (MD)
Entity type:Individual
Prefix:DR
First Name:NEFERTITI
Middle Name:ADUNNI
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 112TH ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3528
Mailing Address - Country:US
Mailing Address - Phone:212-665-5873
Mailing Address - Fax:
Practice Address - Street 1:2200 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2312
Practice Address - Country:US
Practice Address - Phone:310-998-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1258242086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program