Healthcare Provider Details

I. General information

NPI: 1578361598
Provider Name (Legal Business Name): SARA HASELI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET BOX 357233
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

14027 LAKE CITY WAY NE APT S403
SEATTLE WA
98125-3885
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-7200
  • Fax:
Mailing address:
  • Phone: 206-756-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMDRE.ML.61663833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: