Basic Information
| Provider Information | |||||||||
| NPI: | 1568524395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEBELL | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | SHINE FUNCTIONAL MEDICINE | ||||||||
| Address2: | 1700 7TH AVENUE STE 116 PMB 300 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067348370 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1629 N 45TH ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981036701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066333350 | ||||||||
| FaxNumber: | 2066333113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00043969 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.