Provider Demographics
NPI:1932799269
Name:CONRAD, SHAREE NICOLE (LAC)
Entity Type:Individual
Prefix:
First Name:SHAREE
Middle Name:NICOLE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1710 TOPANGA SKYLINE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4038
Mailing Address - Country:US
Mailing Address - Phone:631-307-2360
Mailing Address - Fax:
Practice Address - Street 1:4835 VAN NUYS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2139
Practice Address - Country:US
Practice Address - Phone:631-307-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19004171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist