Provider Demographics
NPI:1730146622
Name:THOMPSON, SHEA HUNTER (LAC, DOM)
Entity type:Individual
Prefix:DR
First Name:SHEA
Middle Name:HUNTER
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1653
Mailing Address - Country:US
Mailing Address - Phone:443-812-1265
Mailing Address - Fax:
Practice Address - Street 1:3905 CORBIN PL
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1653
Practice Address - Country:US
Practice Address - Phone:443-812-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01021171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist