Individual provider Active NPI

Kyle Patrick Shannon, MSN, APRN, FNP-C

  • Nurse Practitioner
  • Vero Beach, FL
National Provider Identifier
1235615766
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11034132 Issued in FL
Practice address
1000 36TH St
Vero Beach, FL 32960-4862
Phone
(772) 567-4311
NPI assigned
Jul 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN.CNP.023482 OH
Family Nurse Practitioner 363LF0000X 11034132 FL
Nurse Practitioner 363L00000X 11034132 FL Primary

Addresses

Primary practice location

1000 36TH St
Vero Beach, FL 32960-4862

Mailing address

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 445-1588

Other practice location 1

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 445-1588

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241220001002 FL Practitioner - Nurse Practitioner 7517219298 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indian River Health Services IncGroup PAC ID 9234130329, 335 clinicians

Practice addresses (Care Compare)

3450 11TH CT
Suite 102
Vero Beach, FL 32960-5012
Phone (772) 778-8687

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
11034132FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Indian River Health Services Inc CurrentSince Jan 6, 2025 Accepting new patients
Indian River Health Services Inc CurrentSince Jan 6, 2025 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1190 37th St
Vero Beach, FL 32960
Phone (772) 563-4666

1000 36th St
Ste 244
Vero Beach, FL 32960
Phone (772) 778-9621

3450 11th Ct
Ste 102
Vero Beach, FL 32960
Phone (772) 778-8687

1000 36th St
Vero Beach, FL 32960
Phone (772) 567-1942

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1235615766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "216-445-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 36TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604862",
            "telephone_number": "772-567-4311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "44195",
            "country_code": "US",
            "telephone_number": "216-445-1588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "KYLE",
        "middle_name": "PATRICK",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-18",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.023482",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11034132",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11034132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

Verify at the official NPI Registry.