Provider Demographics
NPI:1841765005
Name:HEARN, SHAUGHNESSY J
Entity Type:Individual
Prefix:
First Name:SHAUGHNESSY
Middle Name:J
Last Name:HEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 FAWN TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2716
Mailing Address - Country:US
Mailing Address - Phone:832-293-5726
Mailing Address - Fax:
Practice Address - Street 1:7607 FAWN TERRACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2716
Practice Address - Country:US
Practice Address - Phone:832-293-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program