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
1	225400000X	Rehabilitation Practitioner
2	225C00000X	Rehabilitation Counselor	WAIVERED PSYCHOLOGIS	CA
3	103TC0700X	Clinical Psychologist	PSY-25481	CA

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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