Healthcare Provider Details

I. General information

NPI: 1164447793
Provider Name (Legal Business Name): SHASHI LYNN CHURCHILL AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHASHI L CHURCHILL AU.D.

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13119 SEATTLE HILL RD STE 102
SNOHOMISH WA
98296-3402
US

IV. Provider business mailing address

49 FRONT ST N
ISSAQUAH WA
98027-3237
US

V. Phone/Fax

Practice location:
  • Phone: 425-332-3537
  • Fax:
Mailing address:
  • Phone: 425-391-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00002967
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number61428813
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: