Healthcare Provider Details

I. General information

NPI: 1659482578
Provider Name (Legal Business Name): PHYLLIS SANCHEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 3RD AVE STE. 624
SEATTLE WA
98101-2195
US

IV. Provider business mailing address

1402 3RD AVE STE. 624
SEATTLE WA
98101-2195
US

V. Phone/Fax

Practice location:
  • Phone: 206-447-7217
  • Fax: 206-447-7001
Mailing address:
  • Phone: 206-447-7217
  • Fax: 206-447-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY00001443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: