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General NPI Number Information
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NPI Number | 1134759483
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Entity Type | Individual
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Provider Name | LARISSA SHELDON L.AC, M.AC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 7 INNIS AVE
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City | NEW PALTZ
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State | NY
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Zip | 12561-1941
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Country | US
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Telephone | 254-733-9854
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Fax |
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Provider Business Mailing Address
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Address Line | 89 SARGENT AVE
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City | BEACON
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State | NY
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Zip | 12508-3907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 006514
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License Number State | NY
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