Provider Demographics
NPI:1649022401
Name:TAYLOR, SHAUGHNESSY ANN (CRNP)
Entity type:Individual
Prefix:
First Name:SHAUGHNESSY
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SHAUGHNESSY
Other - Middle Name:ANN
Other - Last Name:MIGASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-743-1703
Mailing Address - Fax:570-743-1728
Practice Address - Street 1:33 CINEMA DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2656
Practice Address - Country:US
Practice Address - Phone:717-755-2146
Practice Address - Fax:717-674-7766
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1043127240001Medicaid
PA1043127240002Medicaid