Healthcare Provider Details

I. General information

NPI: 1700343647
Provider Name (Legal Business Name): SHI-LYNNE BERNARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N WICKHAM RD STE 101
MELBOURNE FL
32935-8663
US

IV. Provider business mailing address

3822 S WASHINGTON AVE
TITUSVILLE FL
32780-5845
US

V. Phone/Fax

Practice location:
  • Phone: 321-541-1746
  • Fax: 321-676-2613
Mailing address:
  • Phone: 321-636-6914
  • Fax: 321-636-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001230
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11001230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: