Provider Demographics
NPI:1639606924
Name:KWATRA, SHIVANI (MD)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:KWATRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 14TH AVE NW STE 7
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4619
Mailing Address - Country:US
Mailing Address - Phone:833-411-5469
Mailing Address - Fax:855-459-3020
Practice Address - Street 1:4609 14TH AVE NW STE 7
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4619
Practice Address - Country:US
Practice Address - Phone:833-411-5469
Practice Address - Fax:855-459-3020
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
WAMD61227461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program