NPIMap

Individual provider Active NPI

Shanik J Fernando, MD

  • Otolaryngology Physician
  • Puyallup, WA
National Provider Identifier
1538514179
Registry record updated Aug 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD.MD.70129110 Issued in WA
Practice address
104 27TH Ave SE
Puyallup, WA 98374-1145
Phone
(253) 770-9000
Fax
(253) 770-9712
NPI assigned
May 2, 2016
Last updated
Aug 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD.MD.70129110 WA Primary
Otology & Neurotology Physician 207YX0901X MD.MD.70129110 WA

Addresses

Primary practice location

104 27TH Ave SE
Puyallup, WA 98374-1145

Mailing address

PO Box 1205
Puyallup, WA 98371-0231
Phone (253) 770-9000

Other identifiers 1

IdentifierTypeStateIssuer
2221843MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221018001363 OR Practitioner - OtolaryngologyPractitioner - Pediatric Medicine 0941580179 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Pediatric Medicine
Education
Vanderbilt University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

9205 SW Barnes Rd
Portland, OR 97225-6603

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD209961ORMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Sep 26, 2022 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 26, 2022 Accepting new patients
Providence Health & Services - Oregon CurrentSince Sep 26, 2022 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients
Proliance Surgeons, Inc., P.S. Otolaryngology Past Accepting new patients
Proliance Surgeons Inc PS PastSince Dec 27, 2020 Accepting new patients

Locations

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

9427 SW Barnes Rd
Ste 395
Portland, OR 97225
Phone (503) 216-2602

Interoperability endpoints

  • Direct secure messaging: sfernando2520005@oc.providencedirect.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787875200000",
    "number": "1538514179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1205",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983710231",
            "telephone_number": "253-770-9000",
            "fax_number": "253-770-9712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 27TH AVE SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983741145",
            "telephone_number": "253-770-9000",
            "fax_number": "253-770-9712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDO",
        "first_name": "SHANIK",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-02",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD.MD.70129110",
            "primary": true
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "WA",
            "license": "MD.MD.70129110",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2221843",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.