Provider Demographics
NPI:1265436687
Name:BAILEY, SHANNON LEE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:CASIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12303 NE 130TH LN
Mailing Address - Street 2:SUITE 450
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3099
Mailing Address - Country:US
Mailing Address - Phone:425-899-5000
Mailing Address - Fax:425-899-5006
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE 450
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-899-5000
Practice Address - Fax:425-899-5006
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033219207V00000X
WI51138020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8182362Medicaid
WA8182362Medicaid
G16771Medicare UPIN