Healthcare Provider Details

I. General information

NPI: 1962025213
Provider Name (Legal Business Name): TAYLOR LESLIE SHANNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

630 S RAYMOND AVE UNIT 310
PASADENA CA
91105-3206
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2122
  • Fax:
Mailing address:
  • Phone: 626-598-3770
  • Fax: 626-598-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA181090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: