1417638859 NPI number — SCARLET MADISON SHOUDY ARNP, PNPAC

Table of content: SCARLET MADISON SHOUDY ARNP, PNPAC (NPI 1417638859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417638859 NPI number — SCARLET MADISON SHOUDY ARNP, PNPAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOUDY
Provider First Name:
SCARLET
Provider Middle Name:
MADISON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP, PNPAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INCHES
Provider Other First Name:
SCARLET
Provider Other Middle Name:
MADISON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417638859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15008 40TH AVE W UNIT B1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98087-6499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-320-4964
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SAND POINT WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-987-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2023

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: 363LP0200X , with the licence number:  61632511 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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