MEDICARE: WAY OF WELLNESS HEALTHCARE INC.

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

General Provider Information

NPI Number	:	1417606849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAY OF WELLNESS HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	4719 ATHERTON AVE APT 16
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1002
Country	:	US
Telephone Number	:	408-615-1995
Fax Number	:	408-615-1999

Provider Business Practice Location Address
First Line	:	940 SARATOGA AVE STE 104
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3409
Country	:	US
Telephone Number	:	408-615-1995
Fax Number	:	408-615-1999

Authorized Official
Title or Position	:	CEO
Name	:	DR. SHASTA ERICSON
Credential	:	L.AC., D.A.O.M.
Telephone Number	:	408-615-1995

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2022

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