Provider Demographics
NPI:1689180986
Name:ACUSHARON
Entity Type:Organization
Organization Name:ACUSHARON
Other - Org Name:ACUSHARON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASTER OF ACUPUNCTURE
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LACMAC, DIPLAC
Authorized Official - Phone:207-482-0725
Mailing Address - Street 1:17 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4109
Mailing Address - Country:US
Mailing Address - Phone:207-482-0725
Mailing Address - Fax:
Practice Address - Street 1:251 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6011
Practice Address - Country:US
Practice Address - Phone:207-482-0725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHLEPPING DRUMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-21
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty