MEDICARE: MS. LISA CINDY SHAW L.AC

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	AC17718	CA

General Provider Information

NPI Number	:	1952892366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA CINDY SHAW L.AC

Provider Business Mailing Address
First Line	:	5768 VICENTE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1714
Country	:	US
Telephone Number	:	510-654-4267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 FAIRWAY DR
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-5629
Country	:	US
Telephone Number	:	844-319-1150
Fax Number	:

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

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/21/2018

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