Provider Demographics
NPI:1962697938
Name:SHAUGHNESSY, PATRICIA ELISE (WHNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELISE
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3335
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-4318
Practice Address - Fax:513-584-3020
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN228160363LW0102X
IN28129783A363LW0102X
OH09622363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN228160OtherSTATE LICENSE NUMBER
IN200936880Medicaid
IN000000640123OtherANTHEM PROVIDER NUMBER
IN815500V7Medicare PIN
IN000000640123OtherANTHEM PROVIDER NUMBER
OHRN228160OtherSTATE LICENSE NUMBER