Neutron production is of principal concern when designing proton therapy vault shielding. Conventionally, neutron calculations are based on analytical methods, which do not accurately consider beam shaping components and nozzle shielding. The goal of this study was to calculate, using Monte Carlo modeling, the neutron spectral fluence and neutron dose equivalent generated by a realistic proton therapy nozzle and evaluate how these data could be used in shielding calculations. We modeled a contemporary passive scattering proton therapy nozzle in detail with the MCNPX simulation code. The neutron spectral fluence and dose equivalent at various locations in the treatment room were calculated and compared to those obtained from a thick iron target bombarded by parallel proton beams, the simplified geometry on which analytical methods are based. The neutron spectral fluence distributions were similar for both methods, with deeply penetrating high-energy neutrons (E > 10 MeV) being most prevalent along the beam central axis, and low-energy neutrons predominating the neutron spectral fluence in the lateral region. However, unlike the inverse square falloff used in conventional analytical methods, this study shows that the neutron dose equivalent per therapeutic dose in the treatment room decreased with distance approximately following a power law, with an exponent of about −1.63 in the lateral region and −1.73 in the downstream region. Based on the simulated data according to the detailed nozzle modeling, we developed an empirical equation to estimate the neutron dose equivalent at any location and distance in the treatment vault, e.g. for cases in which detailed Monte Carlo modeling is not feasible. We applied the simulated neutron spectral fluence and dose equivalent to a shielding calculation as an example.