Healthcare Provider Details

I. General information

NPI: 1710015466
Provider Name (Legal Business Name): SHAUN O DOLEN C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 HENDERSONVILLE RD
FLETCHER NC
28732-8241
US

IV. Provider business mailing address

PO BOX 428
SKYLAND NC
28776-0428
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-1644
  • Fax: 828-684-0648
Mailing address:
  • Phone: 828-684-1644
  • Fax: 828-684-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: