MEDICARE: MISS MELODY SHULI SHEN-FAULSTICK OM, L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MA
2	171100000X	Acupuncturist	OM000318	PA

General Provider Information

NPI Number	:	1871043075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELODY SHULI SHEN-FAULSTICK OM, L.AC.

Provider Business Mailing Address
First Line	:	1827 S 8TH ST # 3F
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1659
Country	:	US
Telephone Number	:	857-888-0357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1827 S 8TH ST # 3F
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1659
Country	:	US
Telephone Number	:	857-888-0357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	09/12/2022

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