Healthcare Provider Details

I. General information

NPI: 1538862156
Provider Name (Legal Business Name): VICKEIMA LATOYA SYDNEY BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 WELLNESS BLVD
MONROE NC
28110-7769
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1140
  • Fax: 704-384-1141
Mailing address:
  • Phone: 704-384-1140
  • Fax: 704-384-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-03434
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: