Provider Demographics
NPI:1619001690
Name:SHEN, TERESA T (PHD, LAC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:T
Last Name:SHEN
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 OLD SANTA RITA RD
Mailing Address - Street 2:STE D
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3466
Mailing Address - Country:US
Mailing Address - Phone:925-847-8889
Mailing Address - Fax:925-847-4180
Practice Address - Street 1:3510 OLD SANTA RITA RD
Practice Address - Street 2:D
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3466
Practice Address - Country:US
Practice Address - Phone:925-847-8889
Practice Address - Fax:925-847-4180
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51-0626190OtherTAX ID
CA942854412OtherEMC OLD TAX ID