Provider Demographics
NPI:1104880350
Name:SHAUGHNESSY, MARK (NP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SHAUGHNESSY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PLEASANT HILL RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9688
Mailing Address - Country:US
Mailing Address - Phone:207-560-3770
Mailing Address - Fax:207-560-3128
Practice Address - Street 1:15 PLEASANT HILL RD STE 204
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9688
Practice Address - Country:US
Practice Address - Phone:207-560-3770
Practice Address - Fax:207-560-3128
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECNP81591363LP0808X
ME51968363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health