Provider Demographics
NPI:1164013439
Name:SUN & MOON ACUPUNCTURE AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:SUN & MOON ACUPUNCTURE AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON-SEVERO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, RN
Authorized Official - Phone:718-219-6053
Mailing Address - Street 1:4 PEARL ST APT 301
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4097
Mailing Address - Country:US
Mailing Address - Phone:718-219-6053
Mailing Address - Fax:802-347-2095
Practice Address - Street 1:21 CARMICHAEL ST STE 101
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3186
Practice Address - Country:US
Practice Address - Phone:802-662-1066
Practice Address - Fax:802-347-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center