Healthcare Provider Details

I. General information

NPI: 1356995054
Provider Name (Legal Business Name): SHAWNETTE NATASHA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178-02/04 JAMAICA AVE
JAMAICA NY
11432
US

IV. Provider business mailing address

125 BROAD ST
NEW YORK NY
10004-2400
US

V. Phone/Fax

Practice location:
  • Phone: 516-557-1433
  • Fax:
Mailing address:
  • Phone: 516-557-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007740
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number007740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: