Healthcare Provider Details

I. General information

NPI: 1467699314
Provider Name (Legal Business Name): SHONET ANDRENE BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 H ST STE C-1
MODESTO CA
95354-1221
US

IV. Provider business mailing address

1801 H ST STE C-1
MODESTO CA
95354-1221
US

V. Phone/Fax

Practice location:
  • Phone: 209-544-2554
  • Fax: 209-544-2595
Mailing address:
  • Phone: 209-544-2554
  • Fax: 209-544-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: