Healthcare Provider Details

I. General information

NPI: 1770606337
Provider Name (Legal Business Name): SHAWNNA BURLIN-SHORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWNNA SHORE PPS

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 BARRANCA PKWY
IRVINE CA
92604-4698
US

IV. Provider business mailing address

5050 BARRANCA PKWY
IRVINE CA
92604-4698
US

V. Phone/Fax

Practice location:
  • Phone: 949-936-5841
  • Fax:
Mailing address:
  • Phone: 949-936-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220124890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: