Provider Demographics
NPI:1588842504
Name:DAINTY, SHELLY RAYE (LAC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RAYE
Last Name:DAINTY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:RAYE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2450 E SPEEDWAY BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4748
Mailing Address - Country:US
Mailing Address - Phone:520-369-1999
Mailing Address - Fax:
Practice Address - Street 1:2450 E SPEEDWAY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4748
Practice Address - Country:US
Practice Address - Phone:520-369-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11908171100000X
AZ1060171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist