Provider Demographics
NPI:1679319560
Name:BROWN EDWARDS, SHADELL CATRINA
Entity type:Individual
Prefix:MRS
First Name:SHADELL
Middle Name:CATRINA
Last Name:BROWN EDWARDS
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 1:19560A PECK AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2817
Mailing Address - Country:US
Mailing Address - Phone:917-653-2445
Mailing Address - Fax:
Practice Address - Street 1:19560A PECK AVE APT 1C
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2817
Practice Address - Country:US
Practice Address - Phone:917-653-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach