Healthcare Provider Details

I. General information

NPI: 1982133625
Provider Name (Legal Business Name): AMANDA B BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA B YOUNG PA-C

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29355 NORTHWESTERN HWY STE 302B
SOUTHFIELD MI
48034-1053
US

IV. Provider business mailing address

PO BOX 947977
ATLANTA GA
30394-7977
US

V. Phone/Fax

Practice location:
  • Phone: 248-228-2990
  • Fax:
Mailing address:
  • Phone: 561-223-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008218
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: