Healthcare Provider Details

I. General information

NPI: 1851368575
Provider Name (Legal Business Name): SHABNAM BARNHART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 S. MERIDIAN SUITE 130
PUYALLUP WA
97371
US

IV. Provider business mailing address

11102 SUNRISE BLVD E SUITE 103
PUYALLUP WA
98374
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-8797
  • Fax: 253-845-0100
Mailing address:
  • Phone: 253-848-8797
  • Fax: 253-845-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45513
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60097558
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: