Provider Demographics
NPI:1881464378
Name:HELIODORE, SHADAE (LVN)
Entity type:Individual
Prefix:
First Name:SHADAE
Middle Name:
Last Name:HELIODORE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 PROVIDENCE POINT DR SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7219
Mailing Address - Country:US
Mailing Address - Phone:425-391-2800
Mailing Address - Fax:
Practice Address - Street 1:14517 40TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-5502
Practice Address - Country:US
Practice Address - Phone:860-313-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61215501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse