MEDICARE: SHANEL DAUDY LCSW

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	1041C0700X	Clinical Social Worker	129076	CA

General Provider Information

NPI Number	:	1912516758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANEL DAUDY LCSW

Provider Business Mailing Address
First Line	:	1765 SANTA ANA AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3187
Country	:	US
Telephone Number	:	718-696-9965
Fax Number	:

Provider Business Practice Location Address
First Line	:	1765 SANTA ANA AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3187
Country	:	US
Telephone Number	:	718-696-9965
Fax Number	:

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	02/10/2026

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