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General NPI Number Information
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NPI Number | 1306564992
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Entity Type | Individual
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Provider Name | SHELLBY HOUSE
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Gender | Female
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 525 2ND ST STE 103
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City | EUREKA
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State | CA
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Zip | 95501-0488
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Country | US
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Telephone | 707-296-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 4903 KNEELAND RD
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City | KNEELAND
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State | CA
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Zip | 95549-8504
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Country | US
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Telephone | 707-296-3641
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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 | 19474
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License Number State | CA
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