Provider Demographics
NPI:1760766034
Name:SHPREYREGIN, SVETLANA SR (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:SHPREYREGIN
Suffix:SR
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17555 110TH LN SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6480
Mailing Address - Country:US
Mailing Address - Phone:425-277-3365
Mailing Address - Fax:425-277-3365
Practice Address - Street 1:17555 110TH LN SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6480
Practice Address - Country:US
Practice Address - Phone:425-277-3365
Practice Address - Fax:425-277-3365
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60112669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist