Healthcare Provider Details

I. General information

NPI: 1447812714
Provider Name (Legal Business Name): SHELANDA SHERRALL BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2286 NORTHVIEW ST NE
PALM BAY FL
32905-2630
US

IV. Provider business mailing address

804 JUNIPER LN
MELBOURNE FL
32901-7925
US

V. Phone/Fax

Practice location:
  • Phone: 321-527-0705
  • Fax:
Mailing address:
  • Phone: 321-527-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9349318
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9349318
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN9349318
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN9349318
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9349318
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9349318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: