Individual
SHANE THOMAS GONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2479 E COLORADO BLVD, SPEARFISH, SD 57783-3204
(605) 644-4460
Mailing address
1003 21ST ST NE, WATERTOWN, SD 57201-6700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1635
SD
Other
Enumeration date
09/03/2025
Last updated
09/03/2025
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