Provider Demographics
NPI:1538399928
Name:OSBORNE, SHANNON MAY (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MAY
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 MADRANO DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6932
Mailing Address - Country:US
Mailing Address - Phone:941-373-5353
Mailing Address - Fax:
Practice Address - Street 1:6010 MADRANO DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6932
Practice Address - Country:US
Practice Address - Phone:941-373-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3157-035152W00000X
IL046.010284152W00000X
FLOPC 4611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006706900Medicaid
FLFK389YMedicare PIN