Healthcare Provider Details

I. General information

NPI: 1659280907
Provider Name (Legal Business Name): CARMELITA A SHAMON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 116TH AVE NE
BELLEVUE WA
98004-9971
US

IV. Provider business mailing address

1035 116TH AVE NE
BELLEVUE WA
98004-9971
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-5100
  • Fax: 425-688-5667
Mailing address:
  • Phone: 425-688-5100
  • Fax: 425-688-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN00161145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: