Healthcare Provider Details

I. General information

NPI: 1689776254
Provider Name (Legal Business Name): RICHARD PATRICK SHAUGHNESSY IV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST SUITE 603
PHOENIX AZ
85006-2848
US

IV. Provider business mailing address

3020 E CAMELBACK RD STE 301
PHOENIX AZ
85016-4418
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-6686
  • Fax: 602-254-4258
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number3911
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: