Healthcare Provider Details

I. General information

NPI: 1477767770
Provider Name (Legal Business Name): DIANE MARIE SHANDOR LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 19TH ST NW SUITE 700
WASHINGTON DC
20036-2441
US

IV. Provider business mailing address

1234 19TH ST NW SUITE 700
WASHINGTON DC
20036-2441
US

V. Phone/Fax

Practice location:
  • Phone: 202-463-4993
  • Fax:
Mailing address:
  • Phone: 202-463-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC95
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU00501
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: