Healthcare Provider Details

I. General information

NPI: 1053896050
Provider Name (Legal Business Name): AJAZ BASHIR SHEIKH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 16TH AVE NE SUITE 570
BELLEVUE WA
98004-4632
US

IV. Provider business mailing address

3209 S 23RD ST STE 200
TACOMA WA
98405-1602
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4768
  • Fax: 425-462-8021
Mailing address:
  • Phone: 253-272-5127
  • Fax: 253-404-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60994938
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: