Provider Demographics
NPI:1003568031
Name:FUENTES, SHAY MICHALE
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:MICHALE
Last Name:FUENTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S PUGET DR APT 304
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4329
Mailing Address - Country:US
Mailing Address - Phone:425-761-1542
Mailing Address - Fax:
Practice Address - Street 1:17715 88TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1822
Practice Address - Country:US
Practice Address - Phone:425-761-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide