Healthcare Provider Details

I. General information

NPI: 1649238072
Provider Name (Legal Business Name): SHAWN MICHAEL DONATELLI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7067 TIFFANY BLVD SUITE 230
YOUNGSTOWN OH
44514-1993
US

IV. Provider business mailing address

7067 TIFFANY BLVD SUITE 230
YOUNGSTOWN OH
44514-1993
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-2748
  • Fax: 330-758-3282
Mailing address:
  • Phone: 330-758-2748
  • Fax: 330-758-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34006401
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: