Provider Demographics
NPI:1710015466
Name:DOLEN, SHAUN O (CP)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:O
Last Name:DOLEN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-0428
Mailing Address - Country:US
Mailing Address - Phone:828-684-1644
Mailing Address - Fax:828-684-0648
Practice Address - Street 1:3845 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8241
Practice Address - Country:US
Practice Address - Phone:828-684-1644
Practice Address - Fax:828-684-0648
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225000000X
224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795114Medicaid