Provider Demographics
NPI:1902512437
Name:SHAUGHNESSY, KARINA ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:ALEXANDRIA
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SW SEAFLOWER TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3543
Mailing Address - Country:US
Mailing Address - Phone:951-692-0058
Mailing Address - Fax:
Practice Address - Street 1:120 SW OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2959
Practice Address - Country:US
Practice Address - Phone:772-214-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty