Healthcare Provider Details

I. General information

NPI: 1912405929
Provider Name (Legal Business Name): SHALLY K HUH ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 ISLIP AVE STE 23
ISLIP NY
11751-3225
US

IV. Provider business mailing address

3515 LEVERICH ST APT 501
JACKSON HEIGHTS NY
11372-3906
US

V. Phone/Fax

Practice location:
  • Phone: 631-277-6767
  • Fax: 631-277-4311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number025192
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006073
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: