Healthcare Provider Details

I. General information

NPI: 1861858870
Provider Name (Legal Business Name): IRINA SHLAIN L.AC. A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22055 HIGHWAY 441 N
MICANOPY FL
32667-7525
US

IV. Provider business mailing address

22055 HIGHWAY 441 N
MICANOPY FL
32667-7525
US

V. Phone/Fax

Practice location:
  • Phone: 267-736-3411
  • Fax:
Mailing address:
  • Phone: 352-448-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3560
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: