Individual
FREDERICK BRETT SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
15821 HOLLYFERN CT, FT. MYERS, FL 33908
(239) 432-5100
(239) 432-0629
Mailing address
15880 SUMMERLIN RD, STE 300 PMB 322, FORT MYERS, FL 33908-9612
(239) 432-5100
(239) 432-0629
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
OS4993
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16065
STAYWELL HEALTHY KIDS
FL
01
—
195066
AMERIGROUP
FL
01
—
2017372-007
CIGNA
FL
01
—
207270
AVMED
FL
05
—
372036500
—
FL
01
—
4283415
AETNA
FL
01
—
80729
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/28/2006
Last updated
03/06/2018
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