Provider Demographics
NPI:1881001899
Name:BRASLAVSKY, SHANNON (AGPNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BRASLAVSKY
Suffix:
Gender:F
Credentials:AGPNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 B AVE NE
Mailing Address - Street 2:
Mailing Address - City:WALFORD
Mailing Address - State:IA
Mailing Address - Zip Code:52351-8018
Mailing Address - Country:US
Mailing Address - Phone:501-943-9070
Mailing Address - Fax:319-208-2273
Practice Address - Street 1:3555 STONE CREEK CIR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1240
Practice Address - Country:US
Practice Address - Phone:319-693-8800
Practice Address - Fax:319-208-2273
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2025-01-29
Deactivation Date:2025-01-07
Deactivation Code:
Reactivation Date:2025-01-17
Provider Licenses
StateLicense IDTaxonomies
ARA004140363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology