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9471 Baymeadows Rd Ste 104 Jacksonville FL 32256-7919 | |
| (904) 386-8575 | |
| (904) 900-1140 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 9471 Baymeadows Rd Ste 104, Jacksonville, Florida |
| Authorized Official Name and Position | Shonsierae Brown (LCSW) |
| Authorized Official Contact | 9043868575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4651 Salisbury Rd Ste 400 Jacksonville FL 32256-6187 Ph: (904) 386-8575 | 9471 Baymeadows Rd Ste 104 Jacksonville FL 32256-7919 Ph: (904) 386-8575 |
| NPI Number | 1295367522 |
|---|---|
| Provider Enumeration Date | 02/05/2020 |
| Last Update Date | 08/17/2021 |
| Certification Date | 08/17/2021 |
| Medicare PECOS PAC ID | 8921405317 |
|---|---|
| Medicare Enrollment ID | O20210928001948 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295367522 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shonsierae M Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912399403 PECOS PAC ID: 3577842707 Enrollment ID: I20161110002519 |
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