Healthcare Provider Details

I. General information

NPI: 1578477378
Provider Name (Legal Business Name): TESSA BASTIANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14803 15TH AVE NE
SHORELINE WA
98155-7110
US

IV. Provider business mailing address

14803 15TH AVE NE
SHORELINE WA
98155-7110
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-7282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: