Provider Demographics
NPI:1639612096
Name:SCOLLY, SHANNON MAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MAE
Last Name:SCOLLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ADOBE CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8008
Mailing Address - Country:US
Mailing Address - Phone:617-775-4228
Mailing Address - Fax:
Practice Address - Street 1:126 ADOBE CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8008
Practice Address - Country:US
Practice Address - Phone:617-775-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR9440334163W00000X
VA0001228008163W00000X
FLARNP 9440334367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse