Healthcare Provider Details

I. General information

NPI: 1891466389
Provider Name (Legal Business Name): DESIRAE NICOLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 POCOSHOCK PL STE 102
NORTH CHESTERFIELD VA
23235-6345
US

IV. Provider business mailing address

12104 RESERVE MANOR CIR APT 302
CHESTER VA
23831-3753
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-8705
  • Fax: 804-800-7931
Mailing address:
  • Phone: 804-300-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204000825
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: