Provider Demographics
NPI:1689048225
Name:AIAZIAN, SHARIS MARY (LAC)
Entity Type:Individual
Prefix:MISS
First Name:SHARIS
Middle Name:MARY
Last Name:AIAZIAN
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 1:526 CONNIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1810
Mailing Address - Country:US
Mailing Address - Phone:201-414-1020
Mailing Address - Fax:
Practice Address - Street 1:39 SPRING ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1117
Practice Address - Country:US
Practice Address - Phone:201-414-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00113400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist