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General NPI Number Information
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NPI Number | 1619422508
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Entity Type | Individual
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Provider Name | SHELBY VANDERBROOK LAC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 26 E MAIN ST STE 201
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-1227
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Country | US
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Telephone | 315-906-4042
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 583
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-0583
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Country | US
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Telephone | 315-906-4042
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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 | AK001195
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 006696-01
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License Number State | NY
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