MEDICARE: MR. SHAKIR EDWARD SHY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1528400421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAKIR EDWARD SHY

Provider Business Mailing Address
First Line	:	6330 RUGBY AVE FL 2
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4066
Country	:	US
Telephone Number	:	213-804-1962
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 RUGBY AVE FL 2
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4066
Country	:	US
Telephone Number	:	213-804-1962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	03/11/2026

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Directions to “ MR. SHAKIR EDWARD SHY ” Practice Location

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