MEDICARE: SHANIQUE MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	MD.61325340	WA

General Provider Information

NPI Number	:	1891322772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIQUE MARTIN

Provider Business Mailing Address
First Line	:	1121 30TH AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-3209
Country	:	US
Telephone Number	:	305-904-5408
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 9TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2420
Country	:	US
Telephone Number	:	205-744-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	04/13/2026

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Directions to “ SHANIQUE MARTIN ” Practice Location

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