Healthcare Provider Details

I. General information

NPI: 1023938198
Provider Name (Legal Business Name): SHELBY DONAHUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER STE 200
LOS ANGELES CA
90045-1546
US

IV. Provider business mailing address

1906 LILLIAN AVE
LINESVILLE PA
16424-4516
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: