Healthcare Provider Details

I. General information

NPI: 1013112390
Provider Name (Legal Business Name): SHANTAY MONIQUE DINKS-BROWN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 FEDERAL ST
CAMDEN NJ
08103-1539
US

IV. Provider business mailing address

1315 N. DELAWARE ST
PAULSBORO NJ
08066-1367
US

V. Phone/Fax

Practice location:
  • Phone: 856-541-8217
  • Fax: 856-541-4611
Mailing address:
  • Phone: 856-687-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08341100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: