Provider Demographics
NPI:1598264616
Name:O'SHAUGHNESSY, CONNOR PATRICK (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:PATRICK
Last Name:O'SHAUGHNESSY
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 JIMMY JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2007
Mailing Address - Country:US
Mailing Address - Phone:409-853-5558
Mailing Address - Fax:
Practice Address - Street 1:2555 JIMMY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2007
Practice Address - Country:US
Practice Address - Phone:409-853-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85114133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered