Provider Demographics
NPI:1528613932
Name:O'SHEA, SHAWN ELIZABETH (LAC)
Entity type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:ELIZABETH
Last Name:O'SHEA
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 1:375 LA COLINA DR
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3117
Mailing Address - Country:US
Mailing Address - Phone:949-395-7328
Mailing Address - Fax:
Practice Address - Street 1:519 MAIN ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3006
Practice Address - Country:US
Practice Address - Phone:424-258-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC-18191171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist