Healthcare Provider Details

I. General information

NPI: 1689587685
Provider Name (Legal Business Name): SHANITA BROWN CPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 CONDERSHIRE DR SW
ALBUQUERQUE NM
87121-5253
US

IV. Provider business mailing address

3701 CONDERSHIRE DR SW
ALBUQUERQUE NM
87121-5253
US

V. Phone/Fax

Practice location:
  • Phone: 505-877-3644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2146
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: