Provider Demographics
NPI:1033520226
Name:HENNESSY, SHANE PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:PATRICK
Last Name:HENNESSY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PLAZA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4019
Mailing Address - Country:US
Mailing Address - Phone:724-379-5816
Mailing Address - Fax:724-379-5874
Practice Address - Street 1:800 PLAZA DR STE 400
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012
Practice Address - Country:US
Practice Address - Phone:724-379-5816
Practice Address - Fax:724-379-5813
Is Sole Proprietor?:No
Enumeration Date:2014-05-11
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018852207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine