Healthcare Provider Details

I. General information

NPI: 1255300380
Provider Name (Legal Business Name): MICHAEL WALTER SHAUGHNESSY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7511 LITTLE RD SUITE 101
NEW PORT RICHEY FL
34654-5531
US

IV. Provider business mailing address

5616 LYNN LAKE DR S APT. A
SAINT PETERSBURG FL
33712-6224
US

V. Phone/Fax

Practice location:
  • Phone: 941-544-2175
  • Fax:
Mailing address:
  • Phone: 941-544-2175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9936
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: