Provider Demographics
NPI:1689901878
Name:COVEN, SHANIE (LICAC)
Entity Type:Individual
Prefix:
First Name:SHANIE
Middle Name:
Last Name:COVEN
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 QUARRY AVE
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1416
Mailing Address - Country:US
Mailing Address - Phone:781-812-0057
Mailing Address - Fax:
Practice Address - Street 1:28 QUARRY AVE
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1416
Practice Address - Country:US
Practice Address - Phone:781-812-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist