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General NPI Number Information
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NPI Number | 1467863050
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Entity Type | Organization
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Legal Business Name | SHANTI OM SPA
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 321 NE 2ND AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3801
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Country | US
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Telephone | 561-243-3779
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Fax |
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Provider Business Mailing Address
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Address Line | 321 NE 2ND AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3801
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Country | US
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Telephone | 561-243-3779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARIA ELENA GEGUNDE
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Credential |
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Telephone | 561-243-3779
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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 | AP3327
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License Number State | FL
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