Provider Demographics
NPI:1295582450
Name:MARSHALL, AVERY SYDNEY
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:SYDNEY
Last Name:MARSHALL
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 1:13800 NEWCASTLE GOLF CLUB RD APT 104
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3298
Mailing Address - Country:US
Mailing Address - Phone:971-235-6679
Mailing Address - Fax:
Practice Address - Street 1:13333 NE BEL RED RD STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2332
Practice Address - Country:US
Practice Address - Phone:425-215-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other