Provider Demographics
NPI:1174329627
Name:MCNULTY, AYLIN (LAC)
Entity type:Individual
Prefix:
First Name:AYLIN
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GEE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-5146
Mailing Address - Country:US
Mailing Address - Phone:802-224-6809
Mailing Address - Fax:
Practice Address - Street 1:58 N MAIN ST STE 209
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7205
Practice Address - Country:US
Practice Address - Phone:802-224-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0134112171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist