Healthcare Provider Details

I. General information

NPI: 1548668387
Provider Name (Legal Business Name): AUBREY SHANNON BISHOP DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUBREY SHANNON IVY DVM

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3148 DAVIS BLVD
NAPLES FL
34104-4343
US

IV. Provider business mailing address

3148 DAVIS BLVD
NAPLES FL
34104-4343
US

V. Phone/Fax

Practice location:
  • Phone: 239-774-3701
  • Fax: 239-775-9209
Mailing address:
  • Phone: 239-774-3701
  • Fax: 239-775-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number12736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: