Provider Demographics
NPI:1568524395
Name:DEBELL, MEGAN A (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:DEBELL
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:SHINE FUNCTIONAL MEDICINE
Mailing Address - Street 2:1700 7TH AVENUE STE 116 PMB 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-734-8370
Mailing Address - Fax:
Practice Address - Street 1:1629 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6701
Practice Address - Country:US
Practice Address - Phone:206-633-3350
Practice Address - Fax:206-633-3113
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202136OtherLABOR AND INDUSTRIES
WA8438749Medicaid
I43686Medicare UPIN
WA8438749Medicaid