Provider Demographics
NPI:1396277992
Name:BELLASEA, SHAY LEAH (LMT)
Entity type:Individual
Prefix:MRS
First Name:SHAY
Middle Name:LEAH
Last Name:BELLASEA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEAH
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4130 SW AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4130 SW AUSTIN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-2110
Practice Address - Country:US
Practice Address - Phone:419-350-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60739078225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist