Provider Demographics
NPI:1043584071
Name:SHOUDY, VASHTI (LMP)
Entity Type:Individual
Prefix:MRS
First Name:VASHTI
Middle Name:
Last Name:SHOUDY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 150TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98439-2007
Mailing Address - Country:US
Mailing Address - Phone:253-292-7175
Mailing Address - Fax:
Practice Address - Street 1:7129 150TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98439-2007
Practice Address - Country:US
Practice Address - Phone:253-292-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240930174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist