Healthcare Provider Details

I. General information

NPI: 1538855572
Provider Name (Legal Business Name): SHOULDER STABILITY ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MONSTER RD SW STE 330
RENTON WA
98057-2996
US

IV. Provider business mailing address

1201 MONSTER RD SW STE 330
RENTON WA
98057-2996
US

V. Phone/Fax

Practice location:
  • Phone: 425-429-7573
  • Fax:
Mailing address:
  • Phone: 425-429-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARITY OCONNOR
Title or Position: BILLING SPECIALIST
Credential: RN
Phone: 360-620-0211