MEDICARE: KATHERIN FUNICIELLO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA61282180	WA
2	363A00000X	Physician Assistant	027084	NY
3	363AM0700X	Medical Physician Assistant	PA61282180	WA

General Provider Information

NPI Number	:	1285202630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERIN FUNICIELLO PA

Provider Business Mailing Address
First Line	:	PO BOX 50095
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98145-5095
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 EASTLAKE AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-4405
Country	:	US
Telephone Number	:	206-520-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	03/12/2026

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Directions to “ KATHERIN FUNICIELLO PA” Practice Location

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