Healthcare Provider Details

I. General information

NPI: 1518616143
Provider Name (Legal Business Name): SHAYNA DANIELLE HERNS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23511 56TH AVE W STE 105
MOUNTLAKE TERRACE WA
98043-5285
US

IV. Provider business mailing address

4800 SAND POINT WAY NE, OC.7.830
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-2421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61660608
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: