Healthcare Provider Details

I. General information

NPI: 1831008762
Provider Name (Legal Business Name): JENNIFER LISA SHEA BIANCHI NDTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9623 171ST AVE SE
SNOHOMISH WA
98290-4106
US

IV. Provider business mailing address

9623 171ST AVE SE
SNOHOMISH WA
98290-4106
US

V. Phone/Fax

Practice location:
  • Phone: 425-770-0797
  • Fax:
Mailing address:
  • Phone: 425-770-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number923720
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: