Provider Demographics
NPI:1235767849
Name:SHAUGHNESSY, MICHAEL PAUL JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:SHAUGHNESSY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARKET XING
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7736
Mailing Address - Country:US
Mailing Address - Phone:508-224-3800
Mailing Address - Fax:
Practice Address - Street 1:8 MARKET XING
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7736
Practice Address - Country:US
Practice Address - Phone:508-224-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA283907207R00000X
390200000X
OR219182207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program