Organization
BREVARD PULMONARY SPECIALISTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL SHEPARD (OFFICE MANAGER)
(321) 631-5677
Entity
Organization
Contact information
Practice address
103 LONGWOOD AVE, ROCKLEDGE, FL 32955-2827
(321) 631-5677
(321) 690-0071
Mailing address
103 LONGWOOD AVE, ROCKLEDGE, FL 32955-2827
(321) 631-5677
(321) 690-0071
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
363A00000X
Physician Assistant
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1373308
UNITED MINE WORKERS
FL
Enumeration date
09/20/2006
Last updated
09/11/2025
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