Provider Demographics
NPI:1568629541
Name:ESHTTU, SENAIT
Entity Type:Individual
Prefix:
First Name:SENAIT
Middle Name:
Last Name:ESHTTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22806 45TH PL W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4402
Mailing Address - Country:US
Mailing Address - Phone:206-295-1116
Mailing Address - Fax:
Practice Address - Street 1:5131 COLBY AVE STE B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-3355
Practice Address - Country:US
Practice Address - Phone:425-783-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016778174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist