Provider Demographics
NPI:1881630937
Name:JAIN, SHAILY (MD)
Entity Type:Individual
Prefix:
First Name:SHAILY
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33915 1ST WAY S STE 200
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33915 1ST WAY S STE 200
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6396
Practice Address - Country:US
Practice Address - Phone:253-272-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048192207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00048192OtherWA LICENSE
WA8497034Medicaid
WAMD00048192OtherWA LICENSE
WA000188100Medicare PIN
WAG8851595Medicare PIN
WAG8851597Medicare PIN
WAG8880511Medicare PIN
WA8869153Medicare PIN
WAG8851594Medicare PIN
WAP00671951Medicare PIN
WAG8851596Medicare PIN
WA8497034Medicaid
WA8851594Medicare PIN