Provider Demographics
NPI:1629336722
Name:BEATTY, SHAYLEE TENAE (LMP)
Entity Type:Individual
Prefix:
First Name:SHAYLEE
Middle Name:TENAE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 68TH DR NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-6979
Mailing Address - Country:US
Mailing Address - Phone:425-220-5048
Mailing Address - Fax:
Practice Address - Street 1:3417 68TH DR NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-6979
Practice Address - Country:US
Practice Address - Phone:425-220-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60255992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist