Provider Demographics
NPI:1487944062
Name:TAYLOR, SHABNAM KHASHABI (MD)
Entity type:Individual
Prefix:
First Name:SHABNAM
Middle Name:KHASHABI
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 TOSCANA WAY # E315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5672
Mailing Address - Country:US
Mailing Address - Phone:530-417-5912
Mailing Address - Fax:
Practice Address - Street 1:9415 CAMPUS POINT DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-1350
Practice Address - Country:US
Practice Address - Phone:858-855-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program