Provider Demographics
NPI:1629145925
Name:JOHNSON, SHAYLA ANNE FRISBY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:ANNE FRISBY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAYLA
Other - Middle Name:ANNE
Other - Last Name:FRISBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6507 PACIFIC AVE
Mailing Address - Street 2:#115
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3717
Mailing Address - Country:US
Mailing Address - Phone:925-370-5280
Mailing Address - Fax:925-646-0148
Practice Address - Street 1:2500 ALHAMBRA AVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3156
Practice Address - Country:US
Practice Address - Phone:925-370-5280
Practice Address - Fax:925-646-0148
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38795207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology