Provider Demographics
NPI:1306384300
Name:SHANTIJOY INC
Entity Type:Organization
Organization Name:SHANTIJOY INC
Other - Org Name:SHANTIJOY INTEGRATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-595-5892
Mailing Address - Street 1:5208 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203
Mailing Address - Country:US
Mailing Address - Phone:425-595-5892
Mailing Address - Fax:425-595-5893
Practice Address - Street 1:5208 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203
Practice Address - Country:US
Practice Address - Phone:425-595-5892
Practice Address - Fax:425-595-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60477240175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2046966Medicaid