Provider Demographics
NPI:1073740213
Name:MCMAHON, SHAUN PATRICK
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:PATRICK
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 FAIRVIEW TER
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-6124
Mailing Address - Country:US
Mailing Address - Phone:603-856-5185
Mailing Address - Fax:
Practice Address - Street 1:606 FAIRVIEW TER
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-6124
Practice Address - Country:US
Practice Address - Phone:603-856-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056732-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse