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NPI Code Detail

MEDICARE: BRIENNE SHANNON

MEDICARE: BRIENNE SHANNON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1247200000XOther Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093268054
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIENNE SHANNON
Provider Business Mailing Address
First Line : 414 E 9TH ST
Second Line :
City : APOPKA
State : FL
Zip : 32703-6406
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 151 W CHURCH AVE
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-4105
Country : US
Telephone Number : 407-205-7794
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2016
Last Update Date : 05/23/2019

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Directions to “ BRIENNE SHANNON ” Practice Location

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