Healthcare Provider Details

I. General information

NPI: 1336056860
Provider Name (Legal Business Name): MATTHEW MANNIELLO ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 JUANITA DR NE
KENMORE WA
98028-4966
US

IV. Provider business mailing address

14500 JUANITA DR NE
KENMORE WA
98028-4966
US

V. Phone/Fax

Practice location:
  • Phone: 425-602-3000
  • Fax:
Mailing address:
  • Phone: 425-602-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: