Provider Demographics
NPI:1396893608
Name:MAZZULLA, SHAUNA (OD)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MAZZULLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 228TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7241
Mailing Address - Country:US
Mailing Address - Phone:425-836-5352
Mailing Address - Fax:425-898-9880
Practice Address - Street 1:602 228TH AVE NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7241
Practice Address - Country:US
Practice Address - Phone:425-836-5352
Practice Address - Fax:425-898-9880
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3661 TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist