Provider Demographics
NPI:1588711485
Name:AVANESSIAN, SHAKEH (LAC)
Entity type:Individual
Prefix:MS
First Name:SHAKEH
Middle Name:
Last Name:AVANESSIAN
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:PO BOX 5585
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN CLUB
Mailing Address - State:CA
Mailing Address - Zip Code:93222-5585
Mailing Address - Country:US
Mailing Address - Phone:818-445-5423
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 5585
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN CLUB
Practice Address - State:CA
Practice Address - Zip Code:93222-5585
Practice Address - Country:US
Practice Address - Phone:818-445-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist