Provider Demographics
NPI:1366992489
Name:O'MALLEY, SHAWN (NP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-3319
Mailing Address - Country:US
Mailing Address - Phone:562-900-1626
Mailing Address - Fax:
Practice Address - Street 1:365 W LINDEN AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-3319
Practice Address - Country:US
Practice Address - Phone:562-900-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005214363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology