Provider Demographics
NPI:1609228063
Name:SHROFE, TYLER JACOB
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JACOB
Last Name:SHROFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 26TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-2908
Mailing Address - Country:US
Mailing Address - Phone:360-970-0209
Mailing Address - Fax:
Practice Address - Street 1:5701 6TH AVE SW
Practice Address - Street 2:F-2
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-8507
Practice Address - Country:US
Practice Address - Phone:360-915-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide