MEDICARE: SUSAN L SHELTON LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	0095	AZ

General Provider Information

NPI Number	:	1093857492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L SHELTON LAC

Provider Business Mailing Address
First Line	:	4814 W GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2734
Country	:	US
Telephone Number	:	623-937-9125
Fax Number	:	623-937-1435

Provider Business Practice Location Address
First Line	:	4814 W GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2734
Country	:	US
Telephone Number	:	623-937-9125
Fax Number	:	623-937-1435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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