Provider Demographics
NPI:1295194694
Name:SHAMON ACUPUNCTURE & WELLNESS
Entity Type:Organization
Organization Name:SHAMON ACUPUNCTURE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-678-9897
Mailing Address - Street 1:10801 HICKORY RIDGE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3871
Mailing Address - Country:US
Mailing Address - Phone:301-678-9897
Mailing Address - Fax:
Practice Address - Street 1:4106 GALLATIN ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2132
Practice Address - Country:US
Practice Address - Phone:301-678-9897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty