MEDICARE: DR. DAVID SCOTT SHEN-MILLER PH.D.

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	103T00000X	Psychologist	PY60560787	WA
2	103TC1900X	Counseling Psychologist	PY60560787	WA
3	103TP2701X	Group Psychotherapy Psychologist	PY60560787	WA
4	103TH0100X	Health Service Psychologist	PY60560787	WA

General Provider Information

NPI Number	:	1659679827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SCOTT SHEN-MILLER PH.D.

Provider Business Mailing Address
First Line	:	508 N 82ND ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4306
Country	:	US
Telephone Number	:	541-954-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 N 34TH ST STE 206
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-9089
Country	:	US
Telephone Number	:	541-954-3755
Fax Number	:

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

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	07/21/2022

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