MEDICARE: TREY JOSEPH SHAUGHNESSY 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	5101028886	MI

General Provider Information

NPI Number	:	1871298323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREY JOSEPH SHAUGHNESSY DO

Provider Business Mailing Address
First Line	:	4201 SAINT ANTOINE ST # 9C
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2153
Country	:	US
Telephone Number	:	313-745-5147
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 SAINT ANTOINE ST # 9C
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2153
Country	:	US
Telephone Number	:	313-745-5147
Fax Number	:

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

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	06/17/2026

Similar Medicare Providers

1952106742 — KOLAPO DAIRO
Practice Location Address:

4201 SAINT ANTOINE ST
DETROIT, MI
48201-2153

Practice Phone: 313-577-0804
Practice Fax:

1225898299 — ARINC OZTURK MD
Practice Location Address:

4201 SAINT ANTOINE ST
DETROIT, MI
48201-2153

Practice Phone: 313-745-5146
Practice Fax:

1467385583 — SURYA RAJ SUDARSAN DPM
Practice Location Address:

4201 SAINT ANTOINE ST
DETROIT, MI
48201-2153

Practice Phone: 517-898-1928
Practice Fax:

1750073490 — DR. CONRAD KALEVAS KOVALCIK DO
Practice Location Address:

4201 SAINT ANTOINE ST # 9C
DETROIT, MI
48201-2153

Practice Phone: 313-745-3000
Practice Fax:

1003503111 — DR. STEPHANIE NICOLE STEVENS MD
Practice Location Address:

4201 SAINT ANTOINE ST # 9C
DETROIT, MI
48201-2153

Practice Phone: 313-745-5146
Practice Fax:

1669059705 — JOHN ROBERT EKBLAD DO
Practice Location Address:

4201 SAINT ANTOINE ST
DETROIT, MI
48201-2153

Practice Phone: 970-980-3569
Practice Fax:

Directions to “ TREY JOSEPH SHAUGHNESSY DO” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.