MEDICARE: RICHARD PATRICK SHAUGHNESSY IV DO

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	207RG0100X	Gastroenterology Physician	3911	AZ

General Provider Information

NPI Number	:	1689776254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD PATRICK SHAUGHNESSY IV DO

Provider Business Mailing Address
First Line	:	3020 E CAMELBACK RD STE 301
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4418
Country	:	US
Telephone Number	:	602-264-9100
Fax Number	:	602-264-9101

Provider Business Practice Location Address
First Line	:	1300 N 12TH ST
Second Line	:	SUITE 603
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2848
Country	:	US
Telephone Number	:	602-254-6686
Fax Number	:	602-254-4258

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	06/09/2026

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