Healthcare Provider Details

I. General information

NPI: 1689613085
Provider Name (Legal Business Name): SHANNON L CORBIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST NAVOS MHWC
BURIEN WA
98166-1214
US

IV. Provider business mailing address

1210 SW 136TH ST NAVOS MHWC
BURIEN WA
98166-1214
US

V. Phone/Fax

Practice location:
  • Phone: 206-241-0990
  • Fax: 206-257-6830
Mailing address:
  • Phone: 206-241-0990
  • Fax: 206-257-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00046072
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: