Healthcare Provider Details

I. General information

NPI: 1114835105
Provider Name (Legal Business Name): SHANNON EDDY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8542 1ST AVE NW
SEATTLE WA
98117-3059
US

IV. Provider business mailing address

3515 NE 45TH ST
SEATTLE WA
98105-5640
US

V. Phone/Fax

Practice location:
  • Phone: 206-413-5554
  • Fax:
Mailing address:
  • Phone: 206-402-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT.PT.70162300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: