LISA SHANNON DO PA NPI 1639718836

NPI Information

NPI: 1639718836
Provider Name: LISA SHANNON DO, PA
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
250 2ND ST E STE 3B
BRADENTON, FL
ZIP 34208
Phone: (941) 746-4151
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LISA SHANNON DO, PA is a primary care clinic center in Bradenton, FL. LISA SHANNON DO, PA NPI is 1639718836. The provider is registered as an organization entity type.

The provider's business location address is:

250 2ND ST E STE 3B
BRADENTON, FL
ZIP 34208-027
Phone: (941) 746-4151

The provider's authorized official is Lisa Shannon .
The authorized official title is Physician and has the following contact phone number (941) 746-4151.

The enumeration date for this NPI number is 1/6/2020 and was last updated on 1/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	011944000	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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