Provider Demographics
NPI:1558171520
Name:SHORT, SALENA MISAKO (DACM, LAC, LPN)
Entity type:Individual
Prefix:DR
First Name:SALENA
Middle Name:MISAKO
Last Name:SHORT
Suffix:
Gender:F
Credentials:DACM, LAC, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HORTONS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-5792
Mailing Address - Country:US
Mailing Address - Phone:808-754-1691
Mailing Address - Fax:
Practice Address - Street 1:32 HORTONS CREEK RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-5792
Practice Address - Country:US
Practice Address - Phone:808-754-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN557171100000X
NC2231171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist