Healthcare Provider Details

I. General information

NPI: 1114331972
Provider Name (Legal Business Name): DR. AARON SHADY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CREEKSIDE LOOP
YAKIMA WA
98902-4882
US

IV. Provider business mailing address

3800 SUMMITVIEW AVE
YAKIMA WA
98902-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-1000
  • Fax: 509-225-2703
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-248-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOP60937550
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101021097
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: