Provider Demographics
NPI:1386818367
Name:MURPHY, MARY O'SHAUGHNESSY (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:O'SHAUGHNESSY
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 BRODBECK BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5615
Mailing Address - Country:US
Mailing Address - Phone:407-273-9280
Mailing Address - Fax:
Practice Address - Street 1:10045 BRODBECK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5615
Practice Address - Country:US
Practice Address - Phone:407-273-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889370500Medicaid