Individual
SHANNON DALE O'HARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1265 VISCAYA PKWY, CAPE CORAL, FL 33990-3237
(239) 574-2229
(239) 574-2762
Mailing address
12730 NEW BRITTANY BLVD STE 602, FORT MYERS, FL 33907-4690
(239) 275-5522
(239) 275-4464
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME123468
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014864100
—
FL
01
—
1507R
BCBSFL
FL
01
—
IG110Z
MEDICARE
FL
Enumeration date
03/29/2011
Last updated
10/20/2017
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