Healthcare Provider Details

I. General information

NPI: 1497283287
Provider Name (Legal Business Name): SHANNON CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 W COMMODORE WAY UNIT 100
SEATTLE WA
98199-1287
US

IV. Provider business mailing address

9500 OSUNA RD NE APT 622
ALBUQUERQUE NM
87111-2287
US

V. Phone/Fax

Practice location:
  • Phone: 206-590-0394
  • Fax:
Mailing address:
  • Phone: 206-590-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60760172
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number60760172
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: