Provider Demographics
NPI:1235859307
Name:BRAY, SHANNON (BSN, RNC-OB, C-EFM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:BSN, RNC-OB, C-EFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W EAU GALLIE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5390
Mailing Address - Country:US
Mailing Address - Phone:321-622-5929
Mailing Address - Fax:
Practice Address - Street 1:1301 W EAU GALLIE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5390
Practice Address - Country:US
Practice Address - Phone:321-622-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9246163163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator