Provider Demographics
NPI:1871731372
Name:AESTHETIC ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:AESTHETIC ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHAUGHNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:407-355-9990
Mailing Address - Street 1:7758 WALLACE RD
Mailing Address - Street 2:SUITE X
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7219
Mailing Address - Country:US
Mailing Address - Phone:407-355-9990
Mailing Address - Fax:407-355-9844
Practice Address - Street 1:7758 WALLACE RD
Practice Address - Street 2:SUITE X
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7219
Practice Address - Country:US
Practice Address - Phone:407-355-9990
Practice Address - Fax:407-355-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty