Provider Demographics
NPI:1265085682
Name:NORTH SOUND PEDIATRICS
Entity type:Organization
Organization Name:NORTH SOUND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHLAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-338-5668
Mailing Address - Street 1:15808 MILL CREEK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1500
Mailing Address - Country:US
Mailing Address - Phone:425-338-5668
Mailing Address - Fax:425-338-4366
Practice Address - Street 1:15808 MILL CREEK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1500
Practice Address - Country:US
Practice Address - Phone:425-338-5668
Practice Address - Fax:425-338-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1106749Medicaid