Provider Demographics
NPI:1376618298
Name:SHAW, LEI (L AC)
Entity Type:Individual
Prefix:MRS
First Name:LEI
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 WILDERNESS TRL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4655
Mailing Address - Country:US
Mailing Address - Phone:317-585-0758
Mailing Address - Fax:317-576-9497
Practice Address - Street 1:1020 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1867
Practice Address - Country:US
Practice Address - Phone:317-585-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000007A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist