Healthcare Provider Details

I. General information

NPI: 1912826959
Provider Name (Legal Business Name): TANDI SHAMALLAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANDI SHAMALLAH

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 104TH AVE E UNIT Q304
EDGEWOOD WA
98372-1674
US

IV. Provider business mailing address

1909 104TH AVE E UNIT Q304
EDGEWOOD WA
98372-1674
US

V. Phone/Fax

Practice location:
  • Phone: 425-616-6267
  • Fax:
Mailing address:
  • Phone: 425-616-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP61569561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: