Provider Demographics
NPI:1285948695
Name:SHAH, RIAN NIGHTINGALE (ND)
Entity type:Individual
Prefix:DR
First Name:RIAN
Middle Name:NIGHTINGALE
Last Name:SHAH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:RIAN
Other - Middle Name:NIGHTINGALE
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:450 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-777-6143
Mailing Address - Fax:425-391-8091
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-777-6143
Practice Address - Fax:425-391-8091
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60121488175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath