Healthcare Provider Details

I. General information

NPI: 1417004342
Provider Name (Legal Business Name): SHANNON L ODDI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON L BRANDFASS PA-C

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WATERDAM PLAZA DR STE 2
MC MURRAY PA
15317-5442
US

IV. Provider business mailing address

1900 WATERDAM PLAZA DR STE 2
MC MURRAY PA
15317-5442
US

V. Phone/Fax

Practice location:
  • Phone: 724-260-7531
  • Fax: 724-260-7532
Mailing address:
  • Phone: 724-260-7531
  • Fax: 724-260-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA003103L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: