Provider Demographics
NPI:1487393195
Name:SHAUGHNESSY, ANN MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 SPLITLOG AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-3331
Mailing Address - Country:US
Mailing Address - Phone:816-673-6933
Mailing Address - Fax:
Practice Address - Street 1:10034 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-9326
Practice Address - Country:US
Practice Address - Phone:913-257-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03124208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation