Healthcare Provider Details

I. General information

NPI: 1336712256
Provider Name (Legal Business Name): SHIVALI MASHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16255 NE 87TH ST STE 160
REDMOND WA
98052-7464
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 425-653-4960
  • Fax:
Mailing address:
  • Phone: 206-901-2000
  • Fax: 206-910-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1336712256
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1336712256
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: