1649022401 NPI number — SHAUGHNESSY ANN TAYLOR CRNP

Table of content: SHAUGHNESSY ANN TAYLOR CRNP (NPI 1649022401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649022401 NPI number — SHAUGHNESSY ANN TAYLOR CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
SHAUGHNESSY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIGASH
Provider Other First Name:
SHAUGHNESSY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649022401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 DOCK HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17842-8910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-743-1703
Provider Business Mailing Address Fax Number:
570-743-1728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 CINEMA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17402-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-755-2146
Provider Business Practice Location Address Fax Number:
717-674-7766
Provider Enumeration Date:
04/04/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  SP029177 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043127240001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043127240002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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