Healthcare Provider Details

I. General information

NPI: 1316907108
Provider Name (Legal Business Name): REISHA F BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 CREEKSIDE PKWY STE 208
NAPLES FL
34108-1954
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3000
  • Fax: 392-591-9433
Mailing address:
  • Phone: 239-658-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 94478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: