Healthcare Provider Details

I. General information

NPI: 1083526115
Provider Name (Legal Business Name): BARBERRY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 E MADISON ST OFC 5
SEATTLE WA
98122-2733
US

IV. Provider business mailing address

PO BOX 51218
SEATTLE WA
98115-1218
US

V. Phone/Fax

Practice location:
  • Phone: 360-364-3613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KSENIYA SHIN
Title or Position: OWNER, PROVIDER
Credential: MD, PHD
Phone: 360-364-3613