Provider Demographics
NPI:1043547458
Name:SHORE, KAREN GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:GAIL
Last Name:SHORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:GAIL
Other - Last Name:MENDELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2322 BYRON PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3831
Mailing Address - Country:US
Mailing Address - Phone:310-490-7601
Mailing Address - Fax:
Practice Address - Street 1:2322 BYRON PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3831
Practice Address - Country:US
Practice Address - Phone:310-490-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10095103T00000X
CAPSY18745103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV94961Medicare UPIN