Provider Demographics
NPI:1184041592
Name:SHEARWATER ALLERGY, LLC
Entity Type:Organization
Organization Name:SHEARWATER ALLERGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:MANSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-846-7676
Mailing Address - Street 1:10 FOREST FALLS DR
Mailing Address - Street 2:UNIT 9B
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6936
Mailing Address - Country:US
Mailing Address - Phone:207-846-7676
Mailing Address - Fax:207-846-7675
Practice Address - Street 1:10 FOREST FALLS DR
Practice Address - Street 2:UNIT 9B
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6936
Practice Address - Country:US
Practice Address - Phone:207-846-7676
Practice Address - Fax:207-846-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center