Provider Demographics
NPI:1427247790
Name:GRASS, SHANNON SUE (ANP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:SUE
Last Name:GRASS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-2807
Mailing Address - Country:US
Mailing Address - Phone:727-365-7600
Mailing Address - Fax:
Practice Address - Street 1:2831 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-2807
Practice Address - Country:US
Practice Address - Phone:727-365-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9205247363L00000X
MO2014003270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254016906Medicaid
FL308819700Medicaid