Provider Demographics
NPI:1093872160
Name:SHELL, JOANNA BETH (LAC, MSTCM)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:BETH
Last Name:SHELL
Suffix:
Gender:F
Credentials:LAC, MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 PIONEER CT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1786
Mailing Address - Country:US
Mailing Address - Phone:650-525-9355
Mailing Address - Fax:
Practice Address - Street 1:2041 PIONEER CT
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1786
Practice Address - Country:US
Practice Address - Phone:650-525-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC7676OtherLICENSED ACUPUNCTURIST