=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215849450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSET ACUPUNCTURE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2026
-----------------------------------------------------
Last Update Date | 09/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 164 SUNSET BLVD
-----------------------------------------------------
City | WADING RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11792-1051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-681-9109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 164 SUNSET BLVD
-----------------------------------------------------
City | WADING RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11792-1051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-681-9109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASHLEY TEAGUE
-----------------------------------------------------
Credential | L.AC
-----------------------------------------------------
Telephone | 631-681-9109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------