Provider Demographics
NPI:1699223990
Name:O'DONNELL, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 BUEHLERS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5389
Mailing Address - Country:US
Mailing Address - Phone:216-970-9158
Mailing Address - Fax:
Practice Address - Street 1:5155 BUEHLERS DR STE 103
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5389
Practice Address - Country:US
Practice Address - Phone:330-725-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer