Healthcare Provider Details

I. General information

NPI: 1285365064
Provider Name (Legal Business Name): TABARI BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 DAIRY RD
MELBOURNE FL
32904-4046
US

IV. Provider business mailing address

729 BIANCA DR NE
PALM BAY FL
32905-5605
US

V. Phone/Fax

Practice location:
  • Phone: 321-413-3366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: