Provider Demographics
NPI:1831362938
Name:SHEILA Z. KENNEDY, D.O.
Entity type:Organization
Organization Name:SHEILA Z. KENNEDY, D.O.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-939-1066
Mailing Address - Street 1:820 HARVEY RD
Mailing Address - Street 2:STE E
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4247
Mailing Address - Country:US
Mailing Address - Phone:253-939-1066
Mailing Address - Fax:253-939-1069
Practice Address - Street 1:820 HARVEY RD
Practice Address - Street 2:STE E
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4247
Practice Address - Country:US
Practice Address - Phone:253-939-1066
Practice Address - Fax:253-939-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA193400000XOtherTAXONOMY
E23498Medicare UPIN