MEDICARE: SHANTE BROWN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1790520252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTE BROWN MA

Provider Business Mailing Address
First Line	:	2809 LAKEWOOD DR
Second Line	:
City	:	VIOLET
State	:	LA
Zip	:	70092-3715
Country	:	US
Telephone Number	:	504-491-1356
Fax Number	:

Provider Business Practice Location Address
First Line	:	2809 LAKEWOOD DR
Second Line	:
City	:	VIOLET
State	:	LA
Zip	:	70092-3715
Country	:	US
Telephone Number	:	504-491-1356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	06/26/2024

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Directions to “ SHANTE BROWN MA” Practice Location

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