Active NPI
Kimberly Lynn Shaughnessy
- Speech-Language Pathologist
- Mount Airy, MD
National Provider Identifier
1194364349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 01623L
- Practice address
- 16151 Old Frederick Rd
Mount Airy, MD 21771-3337 - Phone
- (410) 489-6959
- NPI assigned
- Jan 4, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 01623L | MD | Primary |
Addresses
Primary practice location
16151 Old Frederick Rd
Mount Airy, MD 21771-3337
Mailing address
3019 Flint Hill Rd
Adamstown, MD 21710-9210
Phone (501) 940-6986
Other practice location 1
8815 Columbia 100 Pkwy
Columbia, MD 21045-2361
Phone (443) 864-4924
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01623L | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578096000000",
"number": "1194364349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3019 FLINT HILL RD",
"city": "ADAMSTOWN",
"state": "MD",
"postal_code": "217109210",
"telephone_number": "501-940-6986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16151 OLD FREDERICK RD",
"city": "MOUNT AIRY",
"state": "MD",
"postal_code": "217713337",
"telephone_number": "410-489-6959"
}
],
"practiceLocations": [
{
"address_1": "8815 Columbia 100 Pkwy",
"address_purpose": "LOCATION",
"city": "Columbia",
"state": "MD",
"postal_code": "210452361",
"country_code": "US",
"telephone_number": "443-864-4924",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHAUGHNESSY",
"first_name": "KIMBERLY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-04",
"last_updated": "2020-01-04",
"certification_date": "2020-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "01623L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Airy, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.