Provider Demographics
NPI:1114340023
Name:SHOUHED, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SHOUHED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N ROXBURY DR
Mailing Address - Street 2:STE 600
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4225
Mailing Address - Country:US
Mailing Address - Phone:310-651-2040
Mailing Address - Fax:310-651-2055
Practice Address - Street 1:320 S CLARK DR
Practice Address - Street 2:APARTMENT 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3223
Practice Address - Country:US
Practice Address - Phone:310-927-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000048367500000X
CA746862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse