Provider Demographics
NPI:1538296736
Name:SMITH, SHEELAH ROSEMARY (LAC)
Entity Type:Individual
Prefix:
First Name:SHEELAH
Middle Name:ROSEMARY
Last Name:SMITH
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 1:38 S LA CUMBRE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6130
Mailing Address - Country:US
Mailing Address - Phone:805-964-0333
Mailing Address - Fax:805-964-0552
Practice Address - Street 1:38 S LA CUMBRE RD STE 2
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6130
Practice Address - Country:US
Practice Address - Phone:805-964-0333
Practice Address - Fax:805-964-0552
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 3929Medicare ID - Type UnspecifiedSHEELAH R SMITH LAC