Healthcare Provider Details

I. General information

NPI: 1982183430
Provider Name (Legal Business Name): SHAHRUM ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date: 02/15/2026
Reactivation Date: 05/26/2026

III. Provider practice location address

1448 NW MARKET ST STE 210
SEATTLE WA
98107-3743
US

IV. Provider business mailing address

1431 195H PL SW
LYNNWOOD WA
98036
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-8888
  • Fax:
Mailing address:
  • Phone: 425-772-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70100123-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: