1386690105 NPI number — SHELLEY D DONAJKOWSKI L.P.C.

Table of content: SHELLEY D DONAJKOWSKI L.P.C. (NPI 1386690105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386690105 NPI number — SHELLEY D DONAJKOWSKI L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONAJKOWSKI
Provider First Name:
SHELLEY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386690105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12601 NE WOODINVILLE DR.
Provider Second Line Business Mailing Address:
SUITE E1
Provider Business Mailing Address City Name:
WOODINVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-884-1280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 CARING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLMAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49746-8818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-742-4583
Provider Business Practice Location Address Fax Number:
989-742-4298
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  SD008349 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LH00011362 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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