Provider Demographics
NPI:1558985531
Name:SHEN, CORINNA (LAC)
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:
Last Name:SHEN
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 1:205 MALBEC CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1237
Mailing Address - Country:US
Mailing Address - Phone:512-538-5686
Mailing Address - Fax:
Practice Address - Street 1:1603 RANCH ROAD 620 N STE 250
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-2354
Practice Address - Country:US
Practice Address - Phone:512-538-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01973171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist