Healthcare Provider Details

I. General information

NPI: 1891319513
Provider Name (Legal Business Name): IMASHI FERNANDO MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

7600 EVERGREEN WAY
EVERETT WA
98203-6421
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5431
  • Fax: 425-257-1423
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61079597
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: