Healthcare Provider Details

I. General information

NPI: 1477845287
Provider Name (Legal Business Name): CHAIYA E SHERMAN L.AC/EAMP, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9619 FIRDALE AVE
EDMONDS WA
98020-6519
US

IV. Provider business mailing address

9619 FIRDALE AVE
EDMONDS WA
98020-6519
US

V. Phone/Fax

Practice location:
  • Phone: 65-429-8522
  • Fax: 206-260-3656
Mailing address:
  • Phone: 206-542-9852
  • Fax: 206-260-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60735126
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60206851
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: