Chisholm, Shannon Dre

Chisholm, Shannon Dre is an individual health care provider with primary practice located at 3706 N Roosevelt Blvd Suite D, Key West FL 33040-4566. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Chisholm, Shannon Dre can be contacted via phone (305) 517-6613.

Contact Information

Primary practice address
3706 N Roosevelt Blvd Suite D Key West FL 33040-4566
Phone: (305) 517-6613
Fax: (305) 517-6614
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA02625 Texas
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9107966 Florida

Profile Details

NPI number 1700824638
LBN Legal business name Chisholm, Shannon Dre
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 3rd, 2006
Last updated Oct 12th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700824638 NPPES
Texas MEDICAID 216178801
Texas Other P00800517
Texas Other P01064726

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