Provider Demographics
NPI:1740804343
Name:JANES, SHELBY MICHAELA (MS, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MICHAELA
Last Name:JANES
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21917 74TH DR NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6864
Mailing Address - Country:US
Mailing Address - Phone:206-947-2330
Mailing Address - Fax:
Practice Address - Street 1:21917 74TH DR NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6864
Practice Address - Country:US
Practice Address - Phone:206-947-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1613573742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer