Provider Demographics
NPI:1083788475
Name:SHANAHAN, MARTHA JANE (RD, CD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:JANE
Other - Last Name:YARBROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:2372 FRANKLIN AVE E
Mailing Address - Street 2:APT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3330
Mailing Address - Country:US
Mailing Address - Phone:206-399-0140
Mailing Address - Fax:
Practice Address - Street 1:126 AUBURN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5057
Practice Address - Country:US
Practice Address - Phone:206-205-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001835133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457459Medicaid