Provider Demographics
NPI:1669435855
Name:SUSMAN, SHELLEY BREENE (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:BREENE
Last Name:SUSMAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:10445 WILSHIRE BLVD
Mailing Address - Street 2:UNIT 303
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4634
Mailing Address - Country:US
Mailing Address - Phone:310-471-4568
Mailing Address - Fax:310-476-3740
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-757-2222
Practice Address - Fax:818-881-7973
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2012-09-20
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Provider Licenses
StateLicense IDTaxonomies
CAC41775207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72187Medicare UPIN