Doctor Name: | SHANON TYSLAND |
NPI Number: | 1851398754 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RPTL |
License Number: | PT00008170 |
Business Practice Address: | 4030 Alderwood Mall Blvd Lynnwood, WA - 98036 |
Business Phone Number: | 4257760803 |
Business Fax Number: | 4257760813 |
Mailing Address: | 4030 Alderwood Mall Blvd, LYNNWOOD |
State: | WA |
Postal Code: | 98036 |
Phone Number: | 4257760803 |
Fax Number: | 4257760813 |
NPI Enumeration Date: | 07/07/2005 |
NPI Last Update Date: | 02/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | PT00008170 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |