Provider Demographics
NPI:1194834267
Name:ANDREWS, SHAWN M (MD)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:M
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541
Mailing Address - Country:US
Mailing Address - Phone:360-482-3711
Mailing Address - Fax:360-861-8675
Practice Address - Street 1:575 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9551
Practice Address - Country:US
Practice Address - Phone:360-482-3711
Practice Address - Fax:360-861-8675
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA145192OtherLABOR & INDUSTRIES
WA7103815OtherGROUP MEDICAID NUMBER
WA8211963Medicaid
WA8211963Medicaid
WAGAB18055Medicare ID - Type UnspecifiedMEDICARE