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General NPI Number Information
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NPI Number | 1174765697
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Entity Type | Individual
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Provider Name | SHAWNESSY PATRICK O'DELL PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 20688 4TH ST STE B
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City | SARATOGA
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State | CA
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Zip | 95070-5894
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Country | US
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Telephone | 408-603-1496
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 392
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City | SARATOGA
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State | CA
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Zip | 95071-0392
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Country | US
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Telephone | 408-603-1496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23275
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License Number State | CA
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