Provider Demographics
NPI:1053806265
Name:DAVIS BROWN, ROSEADRA CHRISTINE
Entity type:Individual
Prefix:
First Name:ROSEADRA
Middle Name:CHRISTINE
Last Name:DAVIS 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 1:647 ALBANY AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1723
Mailing Address - Country:US
Mailing Address - Phone:914-374-4602
Mailing Address - Fax:
Practice Address - Street 1:647 ALBANY AVE APT 4E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1723
Practice Address - Country:US
Practice Address - Phone:914-374-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency