Provider Demographics
NPI:1578217931
Name:BADANGUIO, SHINDY
Entity Type:Individual
Prefix:
First Name:SHINDY
Middle Name:
Last Name:BADANGUIO
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 1:3023 78TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2822
Mailing Address - Country:US
Mailing Address - Phone:206-236-0776
Mailing Address - Fax:206-236-2467
Practice Address - Street 1:3023 78TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2822
Practice Address - Country:US
Practice Address - Phone:206-236-0776
Practice Address - Fax:206-236-2467
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60586403183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician