Provider Demographics
NPI:1568830313
Name:SHELLER, TIARE (LAC)
Entity Type:Individual
Prefix:
First Name:TIARE
Middle Name:
Last Name:SHELLER
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 1:7033 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1102
Mailing Address - Country:US
Mailing Address - Phone:503-810-6928
Mailing Address - Fax:
Practice Address - Street 1:1046 NE ORENCO STATION PKWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7015
Practice Address - Country:US
Practice Address - Phone:503-505-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC174582171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist