Provider Demographics
NPI:1316905953
Name:MCFARLAND, SHANNON M (PA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:MCFARLAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 PALOMAR AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2459
Mailing Address - Country:US
Mailing Address - Phone:805-479-6730
Mailing Address - Fax:805-641-1737
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91328
Practice Address - Country:US
Practice Address - Phone:818-885-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14911207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14911Medicaid
CAPA14911Medicaid
CAWPA14911EMedicare PIN
CAWPA14911FMedicare PIN
CAWPA14911CMedicare PIN
S77043Medicare UPIN