Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 280257 | MA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD470608 | PA |
NPI | 1912346230 |
---|---|
Provider Name | Dr. Brett Anthony Shannon |
First Address | Rockland, DE 19732-0191 |
Second Address | Bryn Mawr, PA 19010-3239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 13/08/2020 |