Healthcare Provider Details

I. General information

NPI: 1609680487
Provider Name (Legal Business Name): SIGNIFY HEALTH MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 TOWNE CENTRE BLVD STE 250
ANNAPOLIS MD
21401-3599
US

IV. Provider business mailing address

4055 VALLEY VIEW LN STE 700
DALLAS TX
75244-5045
US

V. Phone/Fax

Practice location:
  • Phone: 877-868-5351
  • Fax: 877-900-5078
Mailing address:
  • Phone: 469-466-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SHAWN BRONKE
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 469-466-7424