Provider Demographics
NPI:1609205640
Name:SHELBY, ERIN E (MA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:SHELBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 168TH PL SW APT 107
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3311
Mailing Address - Country:US
Mailing Address - Phone:425-387-9012
Mailing Address - Fax:
Practice Address - Street 1:15021 MAIN ST
Practice Address - Street 2:SUITE K
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1651
Practice Address - Country:US
Practice Address - Phone:425-948-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60237731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist