Healthcare Provider Details

I. General information

NPI: 1285077685
Provider Name (Legal Business Name): AMY J SHEKARCHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ B711 RRUMC
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

14445 OLIVE VIEW DR COTTAGE S
SYLMAR CA
91342
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-9129
  • Fax:
Mailing address:
  • Phone: 747-210-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA134111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: