Provider Demographics
NPI:1104505718
Name:EGAN-MOONEY, SHANNON TAYLOR (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:TAYLOR
Last Name:EGAN-MOONEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:TAYLOR
Other - Last Name:EGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:100 PRISON RD
Mailing Address - Street 2:
Mailing Address - City:REPRESA
Mailing Address - State:CA
Mailing Address - Zip Code:95671-3000
Mailing Address - Country:US
Mailing Address - Phone:831-588-7185
Mailing Address - Fax:
Practice Address - Street 1:100 PRISON RD
Practice Address - Street 2:
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-3000
Practice Address - Country:US
Practice Address - Phone:916-985-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program