=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588025431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE MARIE O'SHAUGHNESSY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2016
-----------------------------------------------------
Last Update Date | 12/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 WELCH ROAD, SUITE DE STANFORD SCHOOL OF MEDICINE, NEPHROLOGY DIVISION
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-725-4738
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 777 WELCH ROAD, SUITE DE STANFORD SCHOOL OF MEDICINE, NEPHROLOGY DIVISION
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-725-4738
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | A138021
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------