Healthcare Provider Details

I. General information

NPI: 1023943404
Provider Name (Legal Business Name): SHWETHA NIKHIL DEVANUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N 130TH ST STE 3
SEATTLE WA
98133-7500
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7444
  • Fax:
Mailing address:
  • Phone: 253-833-7444
  • Fax: 253-661-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.70148026
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: