Provider Demographics
NPI:1174747307
Name:PRUSS, SHARON ELAINE (LAC, DIPLAC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ELAINE
Last Name:PRUSS
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CYPRESS ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6774
Mailing Address - Country:US
Mailing Address - Phone:310-621-4553
Mailing Address - Fax:
Practice Address - Street 1:240 BEDFORD ST STE 5
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3400
Practice Address - Country:US
Practice Address - Phone:310-621-4553
Practice Address - Fax:310-634-1818
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00488171100000X
CA9560171100000X
MA279433171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist