Healthcare Provider Details

I. General information

NPI: 1003836529
Provider Name (Legal Business Name): ERIN D. SHADE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST. SUITE 1500
SEATTLE WA
98104
US

IV. Provider business mailing address

1101 MADISON ST. SUITE 1500
SEATTLE WA
98104
US

V. Phone/Fax

Practice location:
  • Phone: 206-965-1700
  • Fax: 206-965-1736
Mailing address:
  • Phone: 206-965-1700
  • Fax: 206-965-1736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60072835
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001488
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: