Provider Demographics
NPI:1063916328
Name:BROWN, RICHELLE LEE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WILLIAM ST RM 303
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5307
Mailing Address - Country:US
Mailing Address - Phone:716-292-7590
Mailing Address - Fax:888-803-3331
Practice Address - Street 1:156 WILLIAM ST RM 303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5307
Practice Address - Country:US
Practice Address - Phone:716-292-7590
Practice Address - Fax:888-803-3331
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61257363A00000X
FL9116005363A00000X
NY021929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02383255Medicaid