Healthcare Provider Details

I. General information

NPI: 1447012372
Provider Name (Legal Business Name): IVY SHANTELL BROWDER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 CAL CENTER DR STE 340
SACRAMENTO CA
95826-3225
US

IV. Provider business mailing address

8950 CAL CENTER DR STE 340
SACRAMENTO CA
95826-3225
US

V. Phone/Fax

Practice location:
  • Phone: 916-254-5200
  • Fax:
Mailing address:
  • Phone: 916-254-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128755
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: