Healthcare Provider Details

I. General information

NPI: 1629804067
Provider Name (Legal Business Name): WAHEED OSHUNGBOYE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 NE 122ND WAY STE 100
KIRKLAND WA
98034-6927
US

IV. Provider business mailing address

10522 15TH DR SE
EVERETT WA
98208-7700
US

V. Phone/Fax

Practice location:
  • Phone: 425-650-4005
  • Fax:
Mailing address:
  • Phone: 346-918-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70169629-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: