Healthcare Provider Details

I. General information

NPI: 1790508117
Provider Name (Legal Business Name): LIQUID SUNSHINE PSYCHIATRIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N 35TH ST STE 208D
SEATTLE WA
98103-8870
US

IV. Provider business mailing address

4725 46TH AVE S
SEATTLE WA
98118-1819
US

V. Phone/Fax

Practice location:
  • Phone: 206-922-8414
  • Fax: 845-302-8822
Mailing address:
  • Phone: 206-353-4923
  • Fax: 845-302-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANA B CANTONI
Title or Position: OWNER
Credential: PMHNP
Phone: 206-992-2841