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General NPI Number Information
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NPI Number | 1518971225
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Entity Type | Individual
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Provider Name | FREDERICK BRETT SHANNON D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 15821 HOLLYFERN CT
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City | FT. MYERS
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State | FL
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Zip | 33908
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Country | US
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Telephone | 239-432-5100
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Fax | 239-432-0629
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Provider Business Mailing Address
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Address Line | 15880 SUMMERLIN RD STE 300 PMB 322
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City | FORT MYERS
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State | FL
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Zip | 33908-9612
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Country | US
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Telephone | 239-432-5100
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Fax | 239-432-0629
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OS4993
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License Number State | FL
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