Provider Demographics
NPI:1669061297
Name:OSBORN, CODY SHANE
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:SHANE
Last Name:OSBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4942
Mailing Address - Country:US
Mailing Address - Phone:831-601-1131
Mailing Address - Fax:
Practice Address - Street 1:1207 SYLVAN RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4942
Practice Address - Country:US
Practice Address - Phone:831-601-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant