Healthcare Provider Details

I. General information

NPI: 1730083627
Provider Name (Legal Business Name): KONSTANTIN L. SHEFTELEVICH, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 36TH ST STE 327
SEATTLE WA
98103-8699
US

IV. Provider business mailing address

600 N 36TH ST STE 327
SEATTLE WA
98103-8699
US

V. Phone/Fax

Practice location:
  • Phone: 401-523-4111
  • Fax:
Mailing address:
  • Phone: 401-523-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KONSTANTIN SHEFTELEVICH
Title or Position: OWNER, MENTAL HEALTH THERAPIST
Credential: LICSW
Phone: 401-523-4111