Provider Demographics
NPI:1750655577
Name:SHAH, AMELIA LOUISE (BSW)
Entity Type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:LOUISE
Last Name:SHAH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4445 TALBOT RD S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6219
Mailing Address - Country:US
Mailing Address - Phone:425-690-3414
Mailing Address - Fax:425-690-9414
Practice Address - Street 1:4445 TALBOT RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6219
Practice Address - Country:US
Practice Address - Phone:425-690-3414
Practice Address - Fax:425-690-9414
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW61100371104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA210012Medicaid