Provider Demographics
NPI:1821241944
Name:SHELBY, TARA JOHNIE (ND, LM)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:JOHNIE
Last Name:SHELBY
Suffix:
Gender:F
Credentials:ND, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 14TH AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3723
Mailing Address - Country:US
Mailing Address - Phone:206-919-0175
Mailing Address - Fax:206-567-9797
Practice Address - Street 1:5600 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3723
Practice Address - Country:US
Practice Address - Phone:206-919-0175
Practice Address - Fax:206-567-9797
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60026392176B00000X
WANT60058757175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife