Healthcare Provider Details

I. General information

NPI: 1679050645
Provider Name (Legal Business Name): AMARE SHANTIA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 RAINIER AVE S
SEATTLE WA
98118-2706
US

IV. Provider business mailing address

10670 14TH AVE SW APT 220
SEATTLE WA
98146-2131
US

V. Phone/Fax

Practice location:
  • Phone: 206-723-1980
  • Fax: 206-721-3930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: