Provider Demographics
NPI:1710267547
Name:SOFIA, EVA SHEN (ND, RD, LAC)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:SHEN
Last Name:SOFIA
Suffix:
Gender:F
Credentials:ND, RD, LAC
Other - Prefix:DR
Other - First Name:EVA
Other - Middle Name:SHEN
Other - Last Name:KOZURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5122 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4121
Mailing Address - Country:US
Mailing Address - Phone:206-508-1300
Mailing Address - Fax:206-508-1301
Practice Address - Street 1:5122 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4121
Practice Address - Country:US
Practice Address - Phone:206-524-5088
Practice Address - Fax:206-524-5089
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL918610133V00000X
WA60245607171100000X
WANATU.NT.60245488175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQMP000004632075Medicaid