Provider Demographics
NPI:1649228636
Name:SOSZKA, SHAWN SCOTT (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:SCOTT
Last Name:SOSZKA
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5803
Mailing Address - Country:US
Mailing Address - Phone:503-405-9477
Mailing Address - Fax:888-303-5652
Practice Address - Street 1:7215 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5803
Practice Address - Country:US
Practice Address - Phone:503-405-9477
Practice Address - Fax:888-303-5652
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00633171100000X
OR1333175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist