Provider Demographics
NPI:1972624039
Name:MENDONCA, PAMELA A (LIC AC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:MENDONCA
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-1012
Mailing Address - Country:US
Mailing Address - Phone:603-778-7180
Mailing Address - Fax:
Practice Address - Street 1:EAST WIND ACUPUNCTURE
Practice Address - Street 2:210 NORTH HAVERHILL ROAD
Practice Address - City:KENSINGTON
Practice Address - State:NH
Practice Address - Zip Code:03827
Practice Address - Country:US
Practice Address - Phone:603-778-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205543171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist