Provider Demographics
NPI:1952631228
Name:FISHER, SHAWN ANTHONY
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:ANTHONY
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS RHODE ISLAND (SSBN 740)
Mailing Address - Street 2:
Mailing Address - City:FPO-AA
Mailing Address - State:NY
Mailing Address - Zip Code:34092-2136
Mailing Address - Country:US
Mailing Address - Phone:404-310-7566
Mailing Address - Fax:
Practice Address - Street 1:USS RHODE ISLAND (SSBN 740)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34092-2136
Practice Address - Country:US
Practice Address - Phone:404-310-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman