Provider Demographics
NPI:1114090347
Name:FLOWERS, PANTHAYA SHATHIRIS (LMP)
Entity Type:Individual
Prefix:MISS
First Name:PANTHAYA
Middle Name:SHATHIRIS
Last Name:FLOWERS
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 1:927 4TH AVE N
Mailing Address - Street 2:UNIT #1
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3008
Mailing Address - Country:US
Mailing Address - Phone:206-650-9680
Mailing Address - Fax:
Practice Address - Street 1:25725 101ST AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6412
Practice Address - Country:US
Practice Address - Phone:206-650-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist