Provider Demographics
NPI:1811222540
Name:BRILL, SHANNON C (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:BRILL
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10807 FALLS RD
Mailing Address - Street 2:1419
Mailing Address - City:BROOKLANDVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21022-7500
Mailing Address - Country:US
Mailing Address - Phone:410-929-7225
Mailing Address - Fax:
Practice Address - Street 1:10807 FALLS RD
Practice Address - Street 2:1419
Practice Address - City:BROOKLANDVILLE
Practice Address - State:MD
Practice Address - Zip Code:21022-7500
Practice Address - Country:US
Practice Address - Phone:410-929-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167827363LP0808X
CT004426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health