Provider Demographics
NPI:1962000950
Name:O'SHAUGHNESSY, KELLI M (PA-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:M
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6098
Mailing Address - Country:US
Mailing Address - Phone:407-573-3360
Mailing Address - Fax:407-643-2811
Practice Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 206
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6098
Practice Address - Country:US
Practice Address - Phone:407-573-3360
Practice Address - Fax:407-643-2811
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2024-06-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical