MEDICARE: MISS SHEVECIA D BROWN

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	310400000X	Assisted Living Facility	AL12544H	AZ

General Provider Information

NPI Number	:	1891472718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHEVECIA D BROWN

Provider Business Mailing Address
First Line	:	9 OVERHILL RD
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-3003
Country	:	US
Telephone Number	:	845-522-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 W HAYWARD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5749
Country	:	US
Telephone Number	:	184-552-2749
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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Directions to “ MISS SHEVECIA D BROWN ” Practice Location

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