Healthcare Provider Details

I. General information

NPI: 1366285538
Provider Name (Legal Business Name): SHAWN DONTE BROWN M.A., C.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 SARAH LN APT 302
JESSUP MD
20794-3978
US

IV. Provider business mailing address

7808 SARAH LN APT 302
JESSUP MD
20794-3978
US

V. Phone/Fax

Practice location:
  • Phone: 443-800-3077
  • Fax:
Mailing address:
  • Phone: 443-800-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: