Provider Demographics
NPI:1174539019
Name:WERNER, SHELLEY SUNNY (LAC)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:SUNNY
Last Name:WERNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1431 TOWN & COUNTRY DR
Mailing Address - Street 2:#C
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-544-0446
Mailing Address - Fax:707-544-0486
Practice Address - Street 1:1431 TOWN & COUNTRY DR
Practice Address - Street 2:#C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-544-0446
Practice Address - Fax:707-544-0486
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist