Provider Demographics
NPI:1598142945
Name:SHANNON BROWN
Entity type:Organization
Organization Name:SHANNON BROWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AIDE
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:YVETE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-910-9019
Mailing Address - Street 1:3150 BUENA VISTA TER SE APT 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1709
Mailing Address - Country:US
Mailing Address - Phone:202-910-9019
Mailing Address - Fax:
Practice Address - Street 1:5049 D ST SE APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6120
Practice Address - Country:US
Practice Address - Phone:202-910-9019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10820251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health