=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558171520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALENA MISAKO SHORT DACM, LAC, LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 HORTONS CREEK RD
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28714-5792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-754-1691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 HORTONS CREEK RD
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28714-5792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-754-1691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 557
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 2231
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------