Provider Demographics
NPI:1952652497
Name:SHELTON, JOANNA LEI (LAC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LEI
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 STAHL RD STE 123
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1686
Mailing Address - Country:US
Mailing Address - Phone:210-298-5188
Mailing Address - Fax:210-298-5189
Practice Address - Street 1:3851 STAHL RD STE 123
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1686
Practice Address - Country:US
Practice Address - Phone:210-298-5188
Practice Address - Fax:210-298-5189
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC1220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist