Healthcare Provider Details

I. General information

NPI: 1639002223
Provider Name (Legal Business Name): SHANNON LORI CHABOT PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEERFIELD AVE
IRVINE CA
92604-3048
US

IV. Provider business mailing address

4307 DANA
IRVINE CA
92618-0252
US

V. Phone/Fax

Practice location:
  • Phone: 949-936-5692
  • Fax:
Mailing address:
  • Phone: 949-946-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: