Healthcare Provider Details

I. General information

NPI: 1093126807
Provider Name (Legal Business Name): SHANNON FITZPATRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 BLACK SWAN DR STE 201
LEWES DE
19958-4991
US

IV. Provider business mailing address

211 EXECUTIVE DR STE 11
NEWARK DE
19702-3358
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-3311
  • Fax: 302-644-3300
Mailing address:
  • Phone: 302-731-2888
  • Fax: 302-731-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberC1-0026265
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC1-0026265
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: