Provider Demographics
NPI:1407114242
Name:SADOW, SHOSHANA SUSAN (LAC)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:SUSAN
Last Name:SADOW
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 1:943 W 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1704
Mailing Address - Country:US
Mailing Address - Phone:907-399-5655
Mailing Address - Fax:
Practice Address - Street 1:1345 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3236
Practice Address - Country:US
Practice Address - Phone:907-399-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK-24171100000X
AKNCCAOM #3568171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist