Healthcare Provider Details

I. General information

NPI: 1619718947
Provider Name (Legal Business Name): JANAE VICTORIA XHELILI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 56TH ST SW
EVERETT WA
98203-5919
US

IV. Provider business mailing address

1305 56TH ST SW
EVERETT WA
98203-5919
US

V. Phone/Fax

Practice location:
  • Phone: 425-512-9093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.70058561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: