Healthcare Provider Details

I. General information

NPI: 1295582450
Provider Name (Legal Business Name): AVERY SYDNEY MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13333 NE BEL RED RD STE 100
BELLEVUE WA
98005-2332
US

IV. Provider business mailing address

13800 NEWCASTLE GOLF CLUB RD APT 104
NEWCASTLE WA
98059-3298
US

V. Phone/Fax

Practice location:
  • Phone: 425-215-1343
  • Fax:
Mailing address:
  • Phone: 971-235-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: