Provider Demographics
NPI:1134361371
Name:SHAUGHNESSY, JOSEPH NEALON (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NEALON
Last Name:SHAUGHNESSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5053 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2326
Mailing Address - Country:US
Mailing Address - Phone:513-751-2145
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:3301 MERCY HEALTH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1108
Practice Address - Country:US
Practice Address - Phone:513-751-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074457A2085R0001X
KY469692085R0001X
OH35-1296302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100220640Medicaid
IN201244150Medicaid
OH0186241Medicaid
KYK144361Medicare PIN
IN201244150Medicaid
OHP01733186Medicare PIN
OH0186241Medicaid