Provider Demographics
NPI:1225537756
Name:OSBORNE, SHAWN (LICENSED PHLEBOTOMIS)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LICENSED PHLEBOTOMIS
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED PHLEBOTOMIS
Mailing Address - Street 1:1008 DISSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3704
Mailing Address - Country:US
Mailing Address - Phone:678-790-6534
Mailing Address - Fax:
Practice Address - Street 1:1008 DISSTON AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3704
Practice Address - Country:US
Practice Address - Phone:678-790-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL18000031175246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82-475854Medicaid