Provider Demographics
NPI:1053522284
Name:HEWITT, SHANNAH MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNAH
Middle Name:MARIE
Last Name:HEWITT
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:206-401-3156
Mailing Address - Fax:
Practice Address - Street 1:1201 N 175TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5064
Practice Address - Country:US
Practice Address - Phone:206-401-3200
Practice Address - Fax:206-401-3201
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008809207Q00000X
WAMD60014633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2013747Medicaid
WAG8960362Medicare PIN