MEDICARE: SHELBY SICKLES DR L.AC. DACM

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	25MZ00035600	NJ

General Provider Information

NPI Number	:	1942826821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY SICKLES DR L.AC. DACM

Provider Business Mailing Address
First Line	:	901 RAILROAD AVE
Second Line	:
City	:	SPRING LAKE HEIGHTS
State	:	NJ
Zip	:	07762
Country	:	US
Telephone Number	:	732-528-7677
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 RAILROAD AVE
Second Line	:
City	:	SPRING LAKE HEIGHTS
State	:	NJ
Zip	:	07762
Country	:	US
Telephone Number	:	732-528-7677
Fax Number	:

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

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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