Healthcare Provider Details

I. General information

NPI: 1326745795
Provider Name (Legal Business Name): MAO & SHAYA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
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 Number
License Number State

VIII. Authorized Official

Name: DR. FADI SHAYA
Title or Position: PERIODONTIST
Credential: DMD, MSD
Phone: 503-915-0277