Provider Demographics
NPI:1649500034
Name:SOVOLA, SHELLEY ALLISON (LAC,OMD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ALLISON
Last Name:SOVOLA
Suffix:
Gender:F
Credentials:LAC,OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6969
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0355
Mailing Address - Country:US
Mailing Address - Phone:541-469-3354
Mailing Address - Fax:541-469-2180
Practice Address - Street 1:1303 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2322
Practice Address - Country:US
Practice Address - Phone:707-465-3000
Practice Address - Fax:541-469-2180
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1181171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist