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General NPI Number Information
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NPI Number | 1235859307
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Entity Type | Individual
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Provider Name | SHANNON BRAY MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1130 HICKORY ST
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City | MELBOURNE
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State | FL
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Zip | 32901-1973
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Country | US
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Telephone | 321-752-0944
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 321-752-0944
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11039454
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License Number State | FL
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