Provider Demographics
NPI:1083444871
Name:BROWN, CANDICE LASHAYE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LASHAYE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3528
Mailing Address - Country:US
Mailing Address - Phone:757-987-2804
Mailing Address - Fax:
Practice Address - Street 1:5465 VIRGINIA BEACH BLVD STE C
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1757
Practice Address - Country:US
Practice Address - Phone:757-524-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care