Provider Demographics
NPI:1669055984
Name:TADESSE, SHIFERAW
Entity type:Individual
Prefix:
First Name:SHIFERAW
Middle Name:
Last Name:TADESSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 NE 29TH PL APT 333
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7622
Mailing Address - Country:US
Mailing Address - Phone:206-972-5701
Mailing Address - Fax:
Practice Address - Street 1:14500 NE 29TH PL APT 333
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-7622
Practice Address - Country:US
Practice Address - Phone:206-972-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter