Provider Demographics
NPI:1720849177
Name:SHAUGHNESSY, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SHAUGHNESSY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2927
Mailing Address - Country:US
Mailing Address - Phone:603-557-2111
Mailing Address - Fax:
Practice Address - Street 1:215 WYOMING ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2927
Practice Address - Country:US
Practice Address - Phone:603-557-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist