Provider Demographics
NPI:1871136879
Name:BROWN, LATASHA A
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:A
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 1:409 N BROADWAY APT 57
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1936
Mailing Address - Country:US
Mailing Address - Phone:914-563-8880
Mailing Address - Fax:
Practice Address - Street 1:4624 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2102
Practice Address - Country:US
Practice Address - Phone:212-569-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist