Healthcare Provider Details

I. General information

NPI: 1326074881
Provider Name (Legal Business Name): STELLA DESYATNIKOVA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY # 1430 SUITE 1430
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

509 OLIVE WAY # 1430 SUITE 1430
SEATTLE WA
98101-1720
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-3223
  • Fax: 206-682-3224
Mailing address:
  • Phone: 206-682-3223
  • Fax: 206-682-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: STELLA DESYATNIKOVA
Title or Position: OWNER
Credential: MD
Phone: 425-744-1760