Organization
LISA SHANNON DO, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA SHANNON DO (PHYSICIAN)
(941) 746-4151
Entity
Organization
Contact information
Practice address
250 2ND ST E STE 3B, BRADENTON, FL 34208-1027
(941) 746-4151
Mailing address
250 2ND ST E STE 3B, BRADENTON, FL 34208-1027
(941) 746-4151
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011944000
—
FL
Enumeration date
01/06/2020
Last updated
09/06/2023
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