Provider Demographics
NPI:1790175503
Name:WESLEY, SHAMS (AP)
Entity Type:Individual
Prefix:MRS
First Name:SHAMS
Middle Name:
Last Name:WESLEY
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 UNIVERSITY BLVD
Mailing Address - Street 2:APT. 20
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1342
Mailing Address - Country:US
Mailing Address - Phone:561-762-3600
Mailing Address - Fax:
Practice Address - Street 1:4601 MILITARY TRL
Practice Address - Street 2:SUITE 205
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4834
Practice Address - Country:US
Practice Address - Phone:561-624-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3503171100000X
GA000140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist