Provider Demographics
NPI:1609115278
Name:BROWN, STEPHANIE KENYATTA (CPT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:KENYATTA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11931 GREINER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2609
Mailing Address - Country:US
Mailing Address - Phone:313-408-7753
Mailing Address - Fax:
Practice Address - Street 1:18121 E 8 MILE RD STE 330
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3245
Practice Address - Country:US
Practice Address - Phone:313-288-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI246RP1900X, 246R00000X
246YC3302X
MI23D2302134291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based
No291U00000XLaboratoriesClinical Medical Laboratory