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NPI Code Detail

MEDICARE: SHAWN JAMES BRUNELLE PA-C

MEDICARE: SHAWN JAMES BRUNELLE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1457325755
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN JAMES BRUNELLE PA-C
Provider Business Mailing Address
First Line : 262 SUNDROP LN
Second Line :
City : CROSSVILLE
State : TN
Zip : 38571-3677
Country : US
Telephone Number : 931-484-2504
Fax Number :
Provider Business Practice Location Address
First Line : 421 S MAIN ST
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-5048
Country : US
Telephone Number : 931-456-7297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 07/16/2007

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Directions to “ SHAWN JAMES BRUNELLE PA-C” Practice Location

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