MEDICARE: AMY WALL SHORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	226228	MA
2	207L00000X	Anesthesiology Physician	30993	AL
3	207L00000X	Anesthesiology Physician	A123437	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	051120731	OTHER	AL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	051120732	OTHER	AL	BCBS
6	051120734	OTHER	AL	BCBS
7	051120729	OTHER	AL	BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235305566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY WALL SHORE M.D.

Provider Business Mailing Address
First Line	:	1590 ROSECRANS AVE STE D
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3716
Country	:	US
Telephone Number	:	310-737-2844
Fax Number	:

Provider Business Practice Location Address
First Line	:	4553 GLENCOE AVE STE 100
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-7917
Country	:	US
Telephone Number	:	949-988-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	11/15/2025

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