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NPI Code Detail

MEDICARE: DR. SHIR SHANUN PSY.D.

MEDICARE:  DR. SHIR  SHANUN  PSY.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
1225400000XRehabilitation Practitioner
2225C00000XRehabilitation CounselorWAIVERED PSYCHOLOGISCA
3103TC0700XClinical PsychologistPSY-25481CA

General Provider Information

NPI Number : 1962798389
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHIR SHANUN PSY.D.
Provider Business Mailing Address
First Line : 174 W LAS FLORES AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91007-8223
Country : US
Telephone Number : 626-510-2652
Fax Number :
Provider Business Practice Location Address
First Line : 174 W LAS FLORES AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91007-8223
Country : US
Telephone Number : 626-510-2652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2011
Last Update Date : 02/10/2023

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Directions to “ DR. SHIR SHANUN PSY.D.” Practice Location

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