Provider Demographics
NPI:1437987484
Name:BROWN, DESHANTIA WYNETTE
Entity type:Individual
Prefix:
First Name:DESHANTIA
Middle Name:WYNETTE
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 1:914 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-2203
Mailing Address - Country:US
Mailing Address - Phone:850-459-3491
Mailing Address - Fax:
Practice Address - Street 1:914 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-2203
Practice Address - Country:US
Practice Address - Phone:850-459-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide