Provider Demographics
NPI:1437742863
Name:O'NEAL, SHANNON ROSE (ATC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 VAIL AVE STE 200A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1222
Mailing Address - Country:US
Mailing Address - Phone:704-323-2564
Mailing Address - Fax:704-323-3934
Practice Address - Street 1:2001 VAIL AVE STE 200A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1222
Practice Address - Country:US
Practice Address - Phone:704-323-2564
Practice Address - Fax:704-323-3934
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer