Healthcare Provider Details

I. General information

NPI: 1710891387
Provider Name (Legal Business Name): AETHERION LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 COFFEEN AVE STE 1200
SHERIDAN WY
82801-5777
US

IV. Provider business mailing address

1309 COFFEEN AVE STE 1200
SHERIDAN WY
82801-5777
US

V. Phone/Fax

Practice location:
  • Phone: 704-517-7091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LIAM MAHONEY
Title or Position: CEO
Credential:
Phone: 704-517-7091