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General NPI Number Information
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NPI Number | 1558747154
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Entity Type | Individual
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Provider Name | SHAUN MCDONOUGH APN
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Gender | Male
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 81 VERONICA AVE SUITE 203
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City | SOMERSET
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State | NJ
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Zip | 08873-3491
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Country | US
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Telephone | 917-596-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WESTMOUNT DR
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4230
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00581600
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License Number State | NJ
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