Healthcare Provider Details

I. General information

NPI: 1871117820
Provider Name (Legal Business Name): DITI SHETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E MAIN STE D
PUYALLUP WA
98372-5612
US

IV. Provider business mailing address

1200 MERCER ST APT 509
SEATTLE WA
98109-5581
US

V. Phone/Fax

Practice location:
  • Phone: 253-533-5768
  • Fax:
Mailing address:
  • Phone: 804-873-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70032044
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60957666
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: