Provider Demographics
NPI:1154599553
Name:RALPH, SHAUNE D (LIC AC)
Entity type:Individual
Prefix:
First Name:SHAUNE
Middle Name:D
Last Name:RALPH
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 INDIAN HILL ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985-2019
Mailing Address - Country:US
Mailing Address - Phone:978-609-5296
Mailing Address - Fax:
Practice Address - Street 1:218 BOSTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-2200
Practice Address - Country:US
Practice Address - Phone:978-609-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA646171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist