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General NPI Number Information
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NPI Number | 1215806427
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Entity Type | Organization
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Legal Business Name | ETHEREAL WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1645 LIBERTY RD STE 102
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City | SYKESVILLE
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State | MD
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Zip | 21784-6537
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Country | US
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Telephone | 443-398-7018
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 LIBERTY RD STE 102
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City | SYKESVILLE
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State | MD
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Zip | 21784-6537
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Country | US
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Telephone | 443-398-7018
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YANI MAO
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Credential |
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Telephone | 443-398-7018
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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 |
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License Number State |
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