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NPI Code Detail

MEDICARE: SHANNON ASHOORI PA-C

MEDICARE:   SHANNON  ASHOORI  PA-C
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
1363A00000XPhysician AssistantPA64909CA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1679339154
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON ASHOORI PA-C
Provider Business Mailing Address
First Line : 22744 PAUL REVERE DR
Second Line :
City : CALABASAS
State : CA
Zip : 91302-4812
Country : US
Telephone Number : 818-917-0148
Fax Number :
Provider Business Practice Location Address
First Line : 22744 PAUL REVERE DR
Second Line :
City : CALABASAS
State : CA
Zip : 91302-4812
Country : US
Telephone Number : 818-917-0148
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2024
Last Update Date : 12/10/2025

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Directions to “ SHANNON ASHOORI PA-C” Practice Location

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