Healthcare Provider Details

I. General information

NPI: 1962043646
Provider Name (Legal Business Name): SANDRIA DENISE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 MONROE ST
TOLEDO OH
43606-4114
US

IV. Provider business mailing address

3518 MONROE ST
TOLEDO OH
43606-4114
US

V. Phone/Fax

Practice location:
  • Phone: 419-724-4973
  • Fax: 419-724-4974
Mailing address:
  • Phone: 419-724-4973
  • Fax: 419-724-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: