Provider Demographics
NPI:1932072154
Name:BROWN, MALISSA
Entity type:Individual
Prefix:
First Name:MALISSA
Middle Name:
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 1:4155 VETERANS HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6063
Mailing Address - Country:US
Mailing Address - Phone:516-375-0440
Mailing Address - Fax:631-939-2405
Practice Address - Street 1:4155 VETERANS HWY STE 5
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6063
Practice Address - Country:US
Practice Address - Phone:516-375-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist