Provider Demographics
NPI:1033570791
Name:SHAMON, SETH (LAC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:SHAMON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4737
Mailing Address - Country:US
Mailing Address - Phone:202-891-9535
Mailing Address - Fax:
Practice Address - Street 1:1731 CONNECTICUT AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1108
Practice Address - Country:US
Practice Address - Phone:202-743-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02302171100000X
DCAC500245171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist