MEDICARE: SHEN MING CO

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	891	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1861517716	OTHER	FL	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1780049007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEN MING CO

Provider Business Mailing Address
First Line	:	2134 NE 123RD ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2902
Country	:	US
Telephone Number	:	305-981-7958
Fax Number	:	305-981-7961

Provider Business Practice Location Address
First Line	:	2134 NE 123RD ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2902
Country	:	US
Telephone Number	:	305-981-7958
Fax Number	:	305-981-7961

Authorized Official
Title or Position	:	OWNER
Name	:	MS. NANCY DEBORAH CLARK
Credential	:	A.P.
Telephone Number	:	305-981-7958

Provider Enumeration Date	:	12/31/2015
Last Update Date	:	12/31/2015

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Directions to “SHEN MING CO ” Practice Location

Language	Start Address	Practice Location

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