Provider Demographics
NPI:1649741240
Name:SHANKARGANESH, PRIYA
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:
Last Name:SHANKARGANESH
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 1:22703 30TH CT SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4214
Mailing Address - Country:US
Mailing Address - Phone:214-463-4585
Mailing Address - Fax:
Practice Address - Street 1:18311 BOTHELL EVERETT HWY STE 260
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5233
Practice Address - Country:US
Practice Address - Phone:206-437-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician