Provider Demographics
NPI:1013033588
Name:SHIYAN, TATIANA (LMT)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:SHIYAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S 12TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1901
Mailing Address - Country:US
Mailing Address - Phone:253-460-1824
Mailing Address - Fax:253-460-1920
Practice Address - Street 1:4103 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE C
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4300
Practice Address - Country:US
Practice Address - Phone:253-460-1824
Practice Address - Fax:253-460-1920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASH3212OtherREGENCE BLUE SHIELD
WA51594OtherL&I