Provider Demographics
NPI:1871043075
Name:SHEN-FAULSTICK, MELODY SHULI (OM, LAC)
Entity Type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:SHULI
Last Name:SHEN-FAULSTICK
Suffix:
Gender:F
Credentials:OM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 S 8TH ST # 3F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1659
Mailing Address - Country:US
Mailing Address - Phone:857-888-0357
Mailing Address - Fax:
Practice Address - Street 1:1827 S 8TH ST # 3F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1659
Practice Address - Country:US
Practice Address - Phone:857-888-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
PAOM000318171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program