Healthcare Provider Details

I. General information

NPI: 1184329252
Provider Name (Legal Business Name): ELLEN SHRONTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

3707 S RIDGEWAY PL
SEATTLE WA
98144-6217
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-4253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1184329252
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: