Provider Demographics
NPI:1881141539
Name:WARTICKI, SHAWN M (LAC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:WARTICKI
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 1:1824 BRILAND ST
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1965
Mailing Address - Country:US
Mailing Address - Phone:727-481-0337
Mailing Address - Fax:
Practice Address - Street 1:8836 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3848
Practice Address - Country:US
Practice Address - Phone:727-481-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist