Provider Demographics
NPI:1538509039
Name:GALLAGHER, SHAUNA (MD)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 28TH ST APT 865
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6637
Mailing Address - Country:US
Mailing Address - Phone:347-979-4246
Mailing Address - Fax:
Practice Address - Street 1:5 PENN PLZ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1810
Practice Address - Country:US
Practice Address - Phone:646-647-1249
Practice Address - Fax:646-647-1250
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine