Healthcare Provider Details

I. General information

NPI: 1518587534
Provider Name (Legal Business Name): EMMALEE SHAHEEN ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 RYAN ST
LAKE CHARLES LA
70605-2815
US

IV. Provider business mailing address

333 APRIL DR
LAKE CHARLES LA
70611-3928
US

V. Phone/Fax

Practice location:
  • Phone: 337-602-8405
  • Fax:
Mailing address:
  • Phone: 337-513-2418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number326922
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number20-1869
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: