Healthcare Provider Details

I. General information

NPI: 1285295022
Provider Name (Legal Business Name): FADI SHAYA DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 N NORTHGATE WAY STE 215
SEATTLE WA
98133-9018
US

IV. Provider business mailing address

2111 N NORTHGATE WAY STE 215
SEATTLE WA
98133-9018
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-6767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE60886789
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60886789
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: