Healthcare Provider Details

I. General information

NPI: 1659023059
Provider Name (Legal Business Name): MARLAINA JEANELLE BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 WIDEWATERS PKWY
EAST SYRACUSE NY
13057-3072
US

IV. Provider business mailing address

5844 WIDEWATERS PKWY
EAST SYRACUSE NY
13057-3072
US

V. Phone/Fax

Practice location:
  • Phone: 315-471-4911
  • Fax: 315-471-8024
Mailing address:
  • Phone: 315-471-4911
  • Fax: 315-471-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number02933401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: