Healthcare Provider Details

I. General information

NPI: 1184987844
Provider Name (Legal Business Name): MAUREEN O'SHAUGHNESSY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 SLIMESTONE STREET KENTUCKY CLINIC SUITE K401
LEXINGTON KY
40536
US

IV. Provider business mailing address

740 SLIMESTONE STREET KENTUCKY CLINIC SUITE K401
LEXINGTON KY
40536-0284
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-3055
  • Fax: 859-323-2412
Mailing address:
  • Phone: 859-218-3055
  • Fax: 859-323-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number51552
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number51552
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: