Provider Demographics
NPI:1003493156
Name:SHUSTERMAN, NICOLE (ND)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SHUSTERMAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13378 NORTHERN DANCER WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0958
Mailing Address - Country:US
Mailing Address - Phone:469-323-8587
Mailing Address - Fax:
Practice Address - Street 1:17762 PRESTON RD # 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5730
Practice Address - Country:US
Practice Address - Phone:469-323-8587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-00068175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath