Healthcare Provider Details

I. General information

NPI: 1972036267
Provider Name (Legal Business Name): SHANNON MARGARET DALY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 S GRAND AVE
LOS ANGELES CA
90007-3304
US

IV. Provider business mailing address

2829 S GRAND AVE
LOS ANGELES CA
90007-3304
US

V. Phone/Fax

Practice location:
  • Phone: 213-699-7180
  • Fax:
Mailing address:
  • Phone: 213-699-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA158872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: