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General NPI Number Information
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NPI Number | 1285707455
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Entity Type | Individual
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Provider Name | ANGELA P. SHANNON M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 4211 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90011-5622
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Country | US
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Telephone | 323-233-0425
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Fax |
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Provider Business Mailing Address
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Address Line | 2099 FAIRBURN RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-4812
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Country | US
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Telephone | 404-344-0618
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Fax | 404-344-7810
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036661
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C168597
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License Number State | CA
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