Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannia Fullerton

Individual provider Anesthesiology Physician · NPI 1912510124

Shannia Fullerton is an Anesthesiology Assistant in Orlando, Florida. Qualified in 2020, 6 years ago. Practices with Brevard Physician Associates PLLC, a 219-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
6
Licensed in
FL
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

62 Columbia St
Orlando, FL 32806-1115
Phone: (321) 214-4903
Fax: (321) 843-2196
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1775 W Hibiscus Blvd Ste 215, Melbourne, FL 32901-2627 — (321) 837-3820

Specialties & licences

Anesthesiologist Assistant (primary) Taxonomy 367H00000X · Licence AA621 (FL)
Anesthesiology Physician Taxonomy 207L00000X · Licence 32697719 (FL)

Record details

NPI number1912510124
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 26, 2020
Last updated in NPPESDecember 29, 2023
Certification dateDecember 29, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyANESTHESIOLOGY ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Brevard Physician Associates Pllc — 219 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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