Active NPI
Shannon Ly
- Physician Assistant
- Fullerton, CA
National Provider Identifier
1235848268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA61877
- Practice address
- 101 E Valencia Mesa Dr
Fullerton, CA 92835-3809 - Phone
- (714) 651-8138
- NPI assigned
- Nov 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | PA61877 | CA | Primary |
Addresses
Primary practice location
101 E Valencia Mesa Dr
Fullerton, CA 92835-3809
Mailing address
PO Box 505
Temple City, CA 91780-0505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA61877 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675555200000",
"number": "1235848268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 505",
"city": "TEMPLE CITY",
"state": "CA",
"postal_code": "917800505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E VALENCIA MESA DR",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928353809",
"telephone_number": "714-651-8138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-17",
"last_updated": "2023-02-05",
"certification_date": "2023-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA61877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.