Provider Demographics
NPI:1003857475
Name:SHANAA, MANO (MD)
Entity Type:Individual
Prefix:
First Name:MANO
Middle Name:
Last Name:SHANAA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22261 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1833
Mailing Address - Country:US
Mailing Address - Phone:818-854-6427
Mailing Address - Fax:818-854-6428
Practice Address - Street 1:5601 DE SOTO AVE
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6701
Practice Address - Country:US
Practice Address - Phone:818-719-2261
Practice Address - Fax:818-719-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82037207L00000X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A820370OtherBLUE SHIELD
CA00A820370Medicaid
CA00A820370OtherBLUE SHIELD
CAH87121Medicare UPIN