MEDICARE: SHANNON SIMPSON 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
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1700667870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON SIMPSON PA-C

Provider Business Mailing Address
First Line	:	1876 PASSAIC AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7126
Country	:	US
Telephone Number	:	239-994-2824
Fax Number	:

Provider Business Practice Location Address
First Line	:	12751 S CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7732
Country	:	US
Telephone Number	:	239-277-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/13/2023

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Directions to “ SHANNON SIMPSON PA-C” Practice Location

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