Provider Demographics
NPI:1376087940
Name:SHINE FUNCTIONAL MEDICINE LLC
Entity Type:Organization
Organization Name:SHINE FUNCTIONAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:DEBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-734-8370
Mailing Address - Street 1:1700 7TH AVE STE 116
Mailing Address - Street 2:PMB #300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1633 BELLEVUE AVE STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6820
Practice Address - Country:US
Practice Address - Phone:206-734-8370
Practice Address - Fax:206-237-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty