Provider Demographics
NPI:1568681468
Name:O'SHAUGHNESSY, MICHELLE MARIE (LICENSED ACUPUNCTURE)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2633
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040
Mailing Address - Country:US
Mailing Address - Phone:928-640-0678
Mailing Address - Fax:407-355-9844
Practice Address - Street 1:32 NORTH 10TH AVE
Practice Address - Street 2:#3
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:928-640-0678
Practice Address - Fax:407-355-9844
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist