Healthcare Provider Details

I. General information

NPI: 1013100320
Provider Name (Legal Business Name): SHANNON RENEE DOLPHIN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 ENCINITAS BLVD STE 312
ENCINITAS CA
92024-3762
US

IV. Provider business mailing address

333 W D ST APT 1
ENCINITAS CA
92024-3420
US

V. Phone/Fax

Practice location:
  • Phone: 414-803-9305
  • Fax:
Mailing address:
  • Phone: 414-803-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8134
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: