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General NPI Number Information
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NPI Number | 1235615766
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Entity Type | Individual
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Provider Name | KYLE PATRICK SHANNON MSN, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1000 36TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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Country | US
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Telephone | 772-567-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-445-1588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.023482
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11034132
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11034132
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License Number State | FL
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