MEDICARE: SHAWNNA LEE PATTERSON M.D., PH.D.

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
1	2084N0400X	Neurology Physician	2009-01845	NC
2	2084N0400X	Neurology Physician	ME98712	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1205899820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNNA LEE PATTERSON M.D., PH.D.

Provider Business Mailing Address
First Line	:	211 CORAL SANDS DR STE B
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2749
Country	:	US
Telephone Number	:	321-345-6331
Fax Number	:	321-345-3295

Provider Business Practice Location Address
First Line	:	211 CORAL SANDS DR STE B
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2749
Country	:	US
Telephone Number	:	321-345-6331
Fax Number	:	213-453-2953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	02/23/2021

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