MEDICARE: SHANNON ASHOORI PA-C

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	363A00000X	Physician Assistant	PA64909	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1679339154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ASHOORI PA-C

Provider Business Mailing Address
First Line	:	22744 PAUL REVERE DR
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-4812
Country	:	US
Telephone Number	:	818-917-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	22744 PAUL REVERE DR
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-4812
Country	:	US
Telephone Number	:	818-917-0148
Fax Number	:

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

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	12/10/2025

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Directions to “ SHANNON ASHOORI PA-C” Practice Location

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