# O LONGEVITY & WELLNESS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083111371
- **Authorized official:** KEN SHADMAN OTA DO (PHYSICIAN)
- **Authorized official phone:** (480) 365-8035

## Contact information

- **Practice address:** 9821 N 95TH ST STE 101, SCOTTSDALE, AZ 85258-4589
- **Practice address phone:** (480) 416-0403
- **Practice address fax:** (480) 240-5467
- **Mailing address:** 9821 N 95TH ST STE 101, SCOTTSDALE, AZ 85258-4589
- **Mailing address phone:** (480) 365-8035
- **Mailing address fax:** (480) 718-7373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 5305 | AZ | Yes |

## Other

- **Enumeration date:** 04/12/2018
- **Last updated:** 08/30/2019