Healthcare Provider Details

I. General information

NPI: 1588553481
Provider Name (Legal Business Name): SHEWANNA LIVINGSTON N.D, CAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHEWANNA LIVINGSTON N.D, CAM

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 LANCASTER AVE # 4117
PHILADELPHIA PA
19104-1726
US

IV. Provider business mailing address

1800 ASHBOURNE RD UNIT 8901
ELKINS PARK PA
19027-2560
US

V. Phone/Fax

Practice location:
  • Phone: 646-420-4202
  • Fax:
Mailing address:
  • Phone: 267-531-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberZGW3UJDYXM
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: