Healthcare Provider Details

I. General information

NPI: 1669665303
Provider Name (Legal Business Name): SHANNON BRADY-POWERS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON BRADY

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT ST SIXTH FLOOR
PHILADELPHIA PA
19107-4216
US

IV. Provider business mailing address

925 CHESTNUT ST 6TH FLOOR
PHILADELPHIA PA
19107-4216
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6760
  • Fax: 215-923-4532
Mailing address:
  • Phone: 215-955-6760
  • Fax: 215-923-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0601X
TaxonomyOtorhinolaryngology & Head-Neck Registered Nurse
License NumberRN536907
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP009125
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: