Provider Demographics
NPI:1134266828
Name:SHAW, KRISTINA DEBORAH (D ACUP M ST)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DEBORAH
Last Name:SHAW
Suffix:
Gender:F
Credentials:D ACUP M ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 38TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2203
Mailing Address - Country:US
Mailing Address - Phone:206-370-2600
Mailing Address - Fax:
Practice Address - Street 1:7812 LAKE CITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4358
Practice Address - Country:US
Practice Address - Phone:206-370-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002962171100000X
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist