Provider Demographics
NPI:1417004342
Name:ODDI, SHANNON L (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:ODDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:L
Other - Last Name:BRANDFASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1900 WATERDAM PLAZA DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5442
Mailing Address - Country:US
Mailing Address - Phone:724-260-7531
Mailing Address - Fax:724-260-7532
Practice Address - Street 1:1900 WATERDAM PLAZA DR STE 2
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5442
Practice Address - Country:US
Practice Address - Phone:724-260-7531
Practice Address - Fax:724-260-7532
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003103L363A00000X
PAMA-003103-L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant