Provider Demographics
NPI:1467144154
Name:EGGLESTON, SHANNON LEE (NATUROPATH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:NATUROPATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 DOVE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2401
Mailing Address - Country:US
Mailing Address - Phone:714-549-4435
Mailing Address - Fax:
Practice Address - Street 1:1601 DOVE ST STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2401
Practice Address - Country:US
Practice Address - Phone:714-549-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath