Fasullo, Andrea M

Fasullo, Andrea M is an individual health care provider with primary practice located at 33501 1St Way S , Federal Way WA 98003-6208. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Fasullo, Andrea M can be contacted via phone (253) 838-2400.

Contact Information

Primary practice address
33501 1St Way S Federal Way WA 98003-6208
Phone: (253) 838-2400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD00036355 Washington

Profile Details

NPI number 1588689491
LBN Legal business name Fasullo, Andrea M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2006
Last updated Apr 10th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1588689491 NPPES
Washington Other MA9229 BLUE SHIELD
Washington Other US1037387 BLUE SHIELD
Washington Other 0039577 BLUE SHIELD
Washington MEDICAID 8232092 BLUE SHIELD

Popular Providers