Provider Demographics
NPI:1487260980
Name:COSTELLO, SHAYLYNN M (LAC)
Entity type:Individual
Prefix:
First Name:SHAYLYNN
Middle Name:M
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:202 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5731
Mailing Address - Country:US
Mailing Address - Phone:732-779-5064
Mailing Address - Fax:
Practice Address - Street 1:2116 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4672
Practice Address - Country:US
Practice Address - Phone:732-414-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00146000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist