Healthcare Provider Details

I. General information

NPI: 1881155844
Provider Name (Legal Business Name): MS. RAE SHARLEEN PAREDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 MERIDIAN AVE N
SEATTLE WA
98133-9509
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-5850
  • Fax:
Mailing address:
  • Phone: 206-548-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61157452
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: