Provider Demographics
NPI:1942826821
Name:SICKLES, SHELBY (DR LAC DACM)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:SICKLES
Suffix:
Gender:F
Credentials:DR LAC DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07762
Mailing Address - Country:US
Mailing Address - Phone:732-528-7677
Mailing Address - Fax:
Practice Address - Street 1:901 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07762
Practice Address - Country:US
Practice Address - Phone:732-528-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00035600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty