Provider Demographics
NPI:1063209492
Name:SHIFERAW, MATIYAS ASRAT (MD)
Entity type:Individual
Prefix:DR
First Name:MATIYAS
Middle Name:ASRAT
Last Name:SHIFERAW
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 LINDEN AVE N APT E608
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7460
Mailing Address - Country:US
Mailing Address - Phone:206-786-8076
Mailing Address - Fax:
Practice Address - Street 1:917 PACIFIC AVE STE 600
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4437
Practice Address - Country:US
Practice Address - Phone:125-384-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61681840208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice