Healthcare Provider Details

I. General information

NPI: 1992491757
Provider Name (Legal Business Name): SHARI ANTOINETTE BRIGHTLY-BROWN DR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S 2ND ST STE 180
MINNEAPOLIS MN
55454-5000
US

IV. Provider business mailing address

1300 S 2ND ST STE 180
MINNEAPOLIS MN
55454-5000
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-1500
  • Fax:
Mailing address:
  • Phone: 612-625-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP7170
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: