Provider Demographics
NPI:1457173452
Name:PHILON, BROOKLYN N'SHY
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:N'SHY
Last Name:PHILON
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 1:1602 COLUMBUS AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3573
Mailing Address - Country:US
Mailing Address - Phone:567-219-0952
Mailing Address - Fax:
Practice Address - Street 1:1602 COLUMBUS AVE APT 2
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3573
Practice Address - Country:US
Practice Address - Phone:567-219-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVQ0699643747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant