Healthcare Provider Details

I. General information

NPI: 1811940349
Provider Name (Legal Business Name): VICKI A DESHAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 BELLEVUE WAY NE
BELLEVUE WA
98004-5720
US

IV. Provider business mailing address

208 BELLEVUE WAY NE
BELLEVUE WA
98004-5720
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-5596
  • Fax: 425-451-3248
Mailing address:
  • Phone: 425-455-5596
  • Fax: 425-451-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00002762
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: