Shanta Nicole Brown, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

4704261362 Issued in MI

Practice address

24438 Manchester Dr
Brownstown, MI 48134-1888

Phone

(313) 247-4020

NPI assigned

Sep 21, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Snapp Back to Health LLC

  • Adult Health Nurse Practitioner
  • Southfield, MI
  • NPI 1497485254

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1124679188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24438 MANCHESTER DR",
            "city": "BROWNSTOWN",
            "state": "MI",
            "postal_code": "481341888",
            "telephone_number": "248-252-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24438 MANCHESTER DR",
            "city": "BROWNSTOWN",
            "state": "MI",
            "postal_code": "481341888",
            "telephone_number": "313-247-4020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20905 Greenfield Rd Ste 303",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480755347",
            "country_code": "US",
            "telephone_number": "248-450-3177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "SHANTA",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-21",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704261362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Blackburn, NP
• Corey Boland, PTA
• Marley Brereton
• Leanna Bronni, ABOC
• Brown & Brown Consultation Center LLC
• Samantha Nicole Bunch
• Betty A Burkhart, DDS
• Eleni Callis-Dionyssopoulos, D.D.S.
• Care 1 LLC
• Caregivers Alliance LLC

• Primary Care Nurse Practitioner in Brownstown, MI
• Providers in Brownstown, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.