Provider Demographics
NPI:1962501858
Name:WEISLER, SHAWNA L (MD)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:L
Last Name:WEISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13636 VENTURA BLVD # 377
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3700
Mailing Address - Country:US
Mailing Address - Phone:818-432-2392
Mailing Address - Fax:818-514-2380
Practice Address - Street 1:3808 W RIVERSIDE DR STE 406
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-5301
Practice Address - Country:US
Practice Address - Phone:818-432-2392
Practice Address - Fax:818-514-2380
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67610174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH60008Medicare UPIN
W16540Medicare ID - Type Unspecified