Provider Demographics
NPI:1619302478
Name:BRIGHAM, SHANNON ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ROSE
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:ROSE
Other - Last Name:FUHR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:20010 CENTURY BLVD, SUITE 200
Mailing Address - Street 2:EMERGENCY MEDICINE ASSOCIATES
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2330
Practice Address - Street 1:8118 GOOD LUCK ROAD
Practice Address - Street 2:DOCTORS COMMUNITY HOSPITAL
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-552-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant