MEDICARE: SHAUGHNESSY J HEARN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1841765005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUGHNESSY J HEARN

Provider Business Mailing Address
First Line	:	7607 FAWN TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2716
Country	:	US
Telephone Number	:	832-293-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	7607 FAWN TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2716
Country	:	US
Telephone Number	:	832-293-5726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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