Provider Demographics
NPI:1831712561
Name:BROWN, SHALONDA MONIQUE (CPT)
Entity type:Individual
Prefix:
First Name:SHALONDA
Middle Name:MONIQUE
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 1:155 S ACADEMY BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2730
Mailing Address - Country:US
Mailing Address - Phone:424-308-4706
Mailing Address - Fax:
Practice Address - Street 1:155 S ACADEMY BLVD APT 7
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2730
Practice Address - Country:US
Practice Address - Phone:424-308-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20130721021246RP1900X
TX2013720121246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy