Provider Demographics
NPI:1871701169
Name:FASHANT, CHAD DOUGLAS (LMP)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:DOUGLAS
Last Name:FASHANT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17041 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-4449
Mailing Address - Country:US
Mailing Address - Phone:206-218-7648
Mailing Address - Fax:
Practice Address - Street 1:1612 SW DASH POINT RD
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-4530
Practice Address - Country:US
Practice Address - Phone:253-835-5678
Practice Address - Fax:253-835-7342
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist