Provider Demographics
NPI:1588025431
Name:O'SHAUGHNESSY, MICHELLE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:777 WELCH ROAD, SUITE DE
Mailing Address - Street 2:STANFORD SCHOOL OF MEDICINE, NEPHROLOGY DIVISION
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-725-4738
Mailing Address - Fax:
Practice Address - Street 1:777 WELCH ROAD, SUITE DE
Practice Address - Street 2:STANFORD SCHOOL OF MEDICINE, NEPHROLOGY DIVISION
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-725-4738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138021207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology