Provider Demographics
NPI:1649466715
Name:SHUPPERT, SHARON (MS, LAC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:SHUPPERT
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3222
Mailing Address - Country:US
Mailing Address - Phone:512-659-3226
Mailing Address - Fax:
Practice Address - Street 1:1203 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3222
Practice Address - Country:US
Practice Address - Phone:512-659-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00488171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist