Healthcare Provider Details

I. General information

NPI: 1518350420
Provider Name (Legal Business Name): SINA SHAH-HOSSEINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SINA SHAH M.D.

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/15/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

PO BOX 5371
SEATTLE WA
98145-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-8080
  • Fax: 206-987-8081
Mailing address:
  • Phone: 206-987-8080
  • Fax: 206-987-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60999338
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD60999338
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: