Provider Demographics
NPI:1124366604
Name:SHERMAN, ELISABETH MALIA (LAC)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:MALIA
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BEDONS ALY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2522
Mailing Address - Country:US
Mailing Address - Phone:843-814-0428
Mailing Address - Fax:
Practice Address - Street 1:250 MATHIS FERRY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2988
Practice Address - Country:US
Practice Address - Phone:843-814-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCACUP 193171100000X
CAAC 4796171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist