Provider Demographics
NPI:1124773734
Name:SHULKIN, ABBEY JO (LAC)
Entity type:Individual
Prefix:
First Name:ABBEY JO
Middle Name:
Last Name:SHULKIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 NW 2ND AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3855
Mailing Address - Country:US
Mailing Address - Phone:786-368-0076
Mailing Address - Fax:
Practice Address - Street 1:7035 BERACASA WAY STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3454
Practice Address - Country:US
Practice Address - Phone:561-843-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist