Healthcare Provider Details

I. General information

NPI: 1417875964
Provider Name (Legal Business Name): PRESTIGE AFFILIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SCOTCH RD STE 214
EWING NJ
08628-2513
US

IV. Provider business mailing address

214 SCOTCH RD STE 214
EWING NJ
08628-2513
US

V. Phone/Fax

Practice location:
  • Phone: 512-325-6265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RASHEEDA M BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-325-6265