Provider Demographics
NPI:1538726138
Name:GREGORY, SHYLA ANN
Entity type:Individual
Prefix:
First Name:SHYLA
Middle Name:ANN
Last Name:GREGORY
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 1:18650 SE 215TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-0424
Mailing Address - Country:US
Mailing Address - Phone:860-866-6049
Mailing Address - Fax:
Practice Address - Street 1:14434 NE 8TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4146
Practice Address - Country:US
Practice Address - Phone:425-502-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician