Provider Demographics
NPI:1659482578
Name:SANCHEZ, PHYLLIS (PHD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 3RD AVE
Mailing Address - Street 2:STE. 624
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2195
Mailing Address - Country:US
Mailing Address - Phone:206-447-7217
Mailing Address - Fax:206-447-7001
Practice Address - Street 1:1402 3RD AVE
Practice Address - Street 2:STE. 624
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2195
Practice Address - Country:US
Practice Address - Phone:206-447-7217
Practice Address - Fax:206-447-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001443103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8350027Medicaid
S28980Medicare UPIN
8858905Medicare ID - Type Unspecified