Provider Demographics
NPI:1154063857
Name:HINES, SHAON (ND)
Entity Type:Individual
Prefix:DR
First Name:SHAON
Middle Name:
Last Name:HINES
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 1:146768 HAJEC LN
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-5137
Mailing Address - Country:US
Mailing Address - Phone:813-545-4169
Mailing Address - Fax:
Practice Address - Street 1:146768 HAJEC LN
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-5137
Practice Address - Country:US
Practice Address - Phone:888-554-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1709175F00000X
WI6035-170175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath