MEDICARE: MRS. JESSICA M. SHAUGHNESSY-MALLOY L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA31036	FL

General Provider Information

NPI Number	:	1437400900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA M. SHAUGHNESSY-MALLOY L.M.T.

Provider Business Mailing Address
First Line	:	101 S 10TH ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-5303
Country	:	US
Telephone Number	:	863-412-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S 10TH ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-5303
Country	:	US
Telephone Number	:	863-412-9197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	09/25/2012

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