Provider Demographics
NPI:1447875802
Name:SHAKIB, BITA (ND)
Entity type:Individual
Prefix:DR
First Name:BITA
Middle Name:
Last Name:SHAKIB
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6632 S 191ST PL STE E110
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2134
Mailing Address - Country:US
Mailing Address - Phone:425-656-0700
Mailing Address - Fax:
Practice Address - Street 1:1926 SW 164TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2742
Practice Address - Country:US
Practice Address - Phone:253-353-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61062845175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath