=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851309587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELLY-ANN BROWN PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1450 CHAPEL ST.
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-789-3383
-----------------------------------------------------
Fax | 203-789-4262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1450 CHAPEL ST.
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-789-3383
-----------------------------------------------------
Fax | 203-789-4262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 001607
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------