Provider Demographics
NPI:1134806599
Name:SHINKARUK, JARED J (MA61459672)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:J
Last Name:SHINKARUK
Suffix:
Gender:M
Credentials:MA61459672
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 SNOWBERRY LN NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3177
Mailing Address - Country:US
Mailing Address - Phone:360-434-0333
Mailing Address - Fax:
Practice Address - Street 1:1487 NE DAWN RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3122
Practice Address - Country:US
Practice Address - Phone:360-373-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61459672225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist