Provider Demographics
NPI:1386475754
Name:ALTAWEEL, SHIROOK GEORGE
Entity type:Individual
Prefix:
First Name:SHIROOK
Middle Name:GEORGE
Last Name:ALTAWEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 115TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9121
Mailing Address - Country:US
Mailing Address - Phone:425-345-0660
Mailing Address - Fax:
Practice Address - Street 1:4417 115TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9121
Practice Address - Country:US
Practice Address - Phone:425-345-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X
WA111171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter