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General NPI Number Information
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NPI Number | 1164013439
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Entity Type | Organization
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Legal Business Name | SUN & MOON ACUPUNCTURE AND WELLNESS, PLLC
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 21 CARMICHAEL ST STE 101
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-3186
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Country | US
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Telephone | 802-662-1066
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Fax | 802-347-2095
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Provider Business Mailing Address
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Address Line | 4 PEARL ST APT 301
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-4097
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Country | US
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Telephone | 718-219-6053
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Fax | 802-347-2095
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MELANIE RICHARDSON-SEVERO
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Credential | LAC, RN
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Telephone | 718-219-6053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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