Basic Information
Provider Information
NPI: 1003897968
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAMADDON
FirstName: SHERI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 48159
Address2:  
City: BURIEN
State: WA
PostalCode: 981480159
CountryCode: US
TelephoneNumber: 2062441212
FaxNumber: 2062441223
Practice Location
Address1: 16251 SYLVESTER RD SW
Address2:  
City: BURIEN
State: WA
PostalCode: 981663017
CountryCode: US
TelephoneNumber: 2062441212
FaxNumber: 2062441223
Other Information
ProviderEnumerationDate: 11/08/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XMD00038290WAY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
835779005WA MEDICAID
3204TA01WAREGENCE BLUE SHIELDOTHER
893151301WACRIME VICTIMS PGMOTHER
017418701WADEPT OF LABOR & INDUSTRIEOTHER


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