MEDICARE: SHANNON ROONEY

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	1223G0001X	General Practice Dentistry	23790	FL

General Provider Information

NPI Number	:	1972082972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ROONEY

Provider Business Mailing Address
First Line	:	1324 HIGHWAY A1A
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-2408
Country	:	US
Telephone Number	:	321-773-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 HIGHWAY A1A
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-2408
Country	:	US
Telephone Number	:	321-773-6666
Fax Number	:

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	04/19/2019

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Directions to “ SHANNON ROONEY ” Practice Location

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