Provider Demographics
NPI:1619653169
Name:LEONHARD, SHAWN SHANNON (DOM , LAC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:SHANNON
Last Name:LEONHARD
Suffix:
Gender:M
Credentials:DOM , LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:MERCERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17236-0102
Mailing Address - Country:US
Mailing Address - Phone:904-710-1887
Mailing Address - Fax:
Practice Address - Street 1:265 MILL ST STE 500
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6179
Practice Address - Country:US
Practice Address - Phone:301-712-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist