1487063913 NPI number — DR. SHAMAYNE MARIAH BROWN PHD

Table of content: DR. SHAMAYNE MARIAH BROWN PHD (NPI 1487063913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487063913 NPI number — DR. SHAMAYNE MARIAH BROWN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
SHAMAYNE
Provider Middle Name:
MARIAH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487063913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 SOUTH ASPEN ST, STOP 89
Provider Second Line Business Mailing Address:
460 MDG
Provider Business Mailing Address City Name:
BUCKLEY SFB
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 SOUTH ASPEN ST
Provider Second Line Business Practice Location Address:
STOP 89
Provider Business Practice Location Address City Name:
BUCKLEY SFB
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
--
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY60934631 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY00005856 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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