Provider Demographics
NPI:1225477805
Name:DEMARA, SHAUNA E (LAC)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:E
Last Name:DEMARA
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 1:526 CRESCENT BLVD
Mailing Address - Street 2:SUITE213
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4176
Mailing Address - Country:US
Mailing Address - Phone:773-870-0449
Mailing Address - Fax:
Practice Address - Street 1:526 CRESCENT BLVD
Practice Address - Street 2:SUITE213
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4176
Practice Address - Country:US
Practice Address - Phone:773-870-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000913171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist