Provider Demographics
NPI:1699592238
Name:BROWN, SHATIEGA BROWN MONIQUE
Entity type:Individual
Prefix:
First Name:SHATIEGA BROWN
Middle Name:MONIQUE
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 1:4625 LINDELL BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3725
Mailing Address - Country:US
Mailing Address - Phone:314-925-8435
Mailing Address - Fax:314-925-8865
Practice Address - Street 1:4625 LINDELL BLVD STE 216
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3725
Practice Address - Country:US
Practice Address - Phone:314-925-8435
Practice Address - Fax:314-925-8865
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant