1831362938 NPI number — SHEILA Z. KENNEDY, D.O.

Table of content: (NPI 1831362938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831362938 NPI number — SHEILA Z. KENNEDY, D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEILA Z. KENNEDY, D.O.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1831362938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 HARVEY RD
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98002-4247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-939-1066
Provider Business Mailing Address Fax Number:
253-939-1069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 HARVEY RD
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-4247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-939-1066
Provider Business Practice Location Address Fax Number:
253-939-1069
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-939-1066

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OP00001065 , 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)

  • Identifier: 193400000X . This is a "TAXONOMY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com