Provider Demographics
NPI:1194966374
Name:BRILEY, DANIEL SHANE (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SHANE
Last Name:BRILEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 E MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5576
Mailing Address - Country:US
Mailing Address - Phone:479-524-8552
Mailing Address - Fax:
Practice Address - Street 1:2125 E MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-5576
Practice Address - Country:US
Practice Address - Phone:479-524-8552
Practice Address - Fax:479-524-8593
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA289AR363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical