Provider Demographics
NPI:1225797640
Name:FASSNACHT, SHEYANNE LEE (MA60615929)
Entity Type:Individual
Prefix:MRS
First Name:SHEYANNE
Middle Name:LEE
Last Name:FASSNACHT
Suffix:
Gender:F
Credentials:MA60615929
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7702 50TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4639
Mailing Address - Country:US
Mailing Address - Phone:253-508-9809
Mailing Address - Fax:
Practice Address - Street 1:4520 INTELCO LOOP SE STE 4E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6012
Practice Address - Country:US
Practice Address - Phone:360-402-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60615929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist