Shannon Smith, D.O.M., L.AC., L.M.T

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

1098 Issued in NM

Practice address

128 Bridge St
Las Vegas, NM 87701-3427

Phone

(505) 310-3239

NPI assigned

Sep 10, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Shannon Radha Smith-Jory Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378771200000",
    "number": "1003241910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 JESSIE LEE LN",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877015026",
            "telephone_number": "505-310-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 BRIDGE ST",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877013427",
            "telephone_number": "505-310-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANNON",
        "name_prefix": "Ms.",
        "credential": "D.O.M., L.AC., L.M.T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-10",
        "last_updated": "2013-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NM",
            "license": "1098",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NM",
            "license": "0351",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "SMITH-JORY",
            "middle_name": "RADHA",
            "prefix": "MS.",
            "credential": "L.M.T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Adrienne Sloan
• Ivan Smith
• Jason Smith, BMS
• Patricia Ann Smith, LMSW
• Serena R Smith, BMS
• Tomasita Jasmine Smith
• Smyrna Enterprises, Inc (Quality Continuum Hospice & Home HealthCare)
• Anthony M Soares, BMS
• Renee A Soderlund, MAOTR/L
• Jason I Solano, PHARMD

• Acupuncturist in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• Acupuncturist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.