Provider Demographics
NPI:1619402542
Name:O'SHAUGHNESSY, BRADEN (DO)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:O'SHAUGHNESSY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3125 OLD FAIRHAVEN PKWY STE 106
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-8266
Practice Address - Country:US
Practice Address - Phone:360-788-8388
Practice Address - Fax:360-788-8389
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16736207Q00000X
390200000X
WAOP61321863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program