Healthcare Provider Details

I. General information

NPI: 1497967038
Provider Name (Legal Business Name): JESSICA SUZANNE SHEAFFER L.M.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 NE 72ND ST STE 6
SEATTLE WA
98115-5456
US

IV. Provider business mailing address

402 NE 72ND ST STE 6
SEATTLE WA
98115-5456
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-5511
  • Fax: 206-524-5512
Mailing address:
  • Phone: 206-524-5511
  • Fax: 206-524-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00015771
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: