MEDICARE: SHANNON NAND

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	225X00000X	Occupational Therapist	OT14264	FL

General Provider Information

NPI Number	:	1881213171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON NAND

Provider Business Mailing Address
First Line	:	8300 WHISKEY PRESERVE CIR APT 124
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13881 EAGLE RIDGE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-1866
Country	:	US
Telephone Number	:	239-561-7700
Fax Number	:

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

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	04/16/2020

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Directions to “ SHANNON NAND ” Practice Location

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