Provider Demographics
NPI:1881033785
Name:MITTELMAN, SHIRLY (IBCLC, PCD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:SHIRLY
Middle Name:
Last Name:MITTELMAN
Suffix:
Gender:F
Credentials:IBCLC, PCD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16530 NE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5431
Mailing Address - Country:US
Mailing Address - Phone:425-442-7012
Mailing Address - Fax:
Practice Address - Street 1:16530 NE 48TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5431
Practice Address - Country:US
Practice Address - Phone:425-442-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN