Provider Demographics
NPI:1033593330
Name:ISME, SHIRLEY (LAC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ISME
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:487 BALDWINS PATH
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729
Mailing Address - Country:US
Mailing Address - Phone:917-557-3837
Mailing Address - Fax:631-752-1659
Practice Address - Street 1:6 WESTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4031
Practice Address - Country:US
Practice Address - Phone:917-557-3837
Practice Address - Fax:631-753-1659
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005605-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist