Healthcare Provider Details

I. General information

NPI: 1528385747
Provider Name (Legal Business Name): SHELDON LEE BROWN DPM, CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE PEDIATRIC EMERGENCY DEPARTMENT
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

62 MAYBERRY PROMENADE
STATEN ISLAND NY
10312-6407
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-5430
  • Fax:
Mailing address:
  • Phone: 718-581-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN-3895
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN07424400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number307046
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: