Healthcare Provider Details

I. General information

NPI: 1538080460
Provider Name (Legal Business Name): ISAIAH J MAHONEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 POPLAR PL S
SEATTLE WA
98144-2827
US

IV. Provider business mailing address

861 POPLAR PL S
SEATTLE WA
98144-2827
US

V. Phone/Fax

Practice location:
  • Phone: 844-987-9274
  • Fax: 206-838-1851
Mailing address:
  • Phone: 844-987-9274
  • Fax: 206-838-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: