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General NPI Number Information
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NPI Number | 1205080553
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Entity Type | Individual
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Provider Name | SHANTHY SANDRASEKARAMUDALY BROWN O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 6633 GERMANTOWN AVE UNIT A
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2253
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Country | US
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Telephone | 215-422-3636
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Fax | 215-422-3748
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Provider Business Mailing Address
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Address Line | 615 S CONESTOGA ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2514
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Country | US
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Telephone | 215-305-0611
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002168
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License Number State | PA
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