=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386558708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING INK TATTOO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 W 1ST ST
-----------------------------------------------------
City | WACONIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55387-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-982-4876
-----------------------------------------------------
Fax | 407-650-2758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 W 1ST ST
-----------------------------------------------------
City | WACONIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55387-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-982-4876
-----------------------------------------------------
Fax | 407-650-2758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHERYL RAE SHOHET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-982-4876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246Z00000X
-----------------------------------------------------
Taxonomy Name | Other Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------