Warren Shadko, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61098454 Issued in WA

Practice address

11335 NE 122ND Way Ste 105
Kirkland, WA 98034-6933

Phone

(425) 298-7480

NPI assigned

Jan 13, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1538709092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11335 NE 122ND WAY STE 105",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346933",
            "telephone_number": "425-298-7480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11335 NE 122ND WAY STE 105",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346933",
            "telephone_number": "425-298-7480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3430 E Russell Rd Ste 301-40",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891202201",
            "country_code": "US",
            "telephone_number": "425-298-7480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADKO",
        "first_name": "WARREN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-13",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NC",
            "license": "277126",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5012834",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "836257",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61098454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rozanni Senanayake, MS, OTR/L, CHT, CEAS
• Peter Ser, MD
• Barbara Jean Severson, ARNP
• Justin Illick Seyfried
• Brittany Seyl
• Pina Shah Mehta, D.P.T.
• Akhil B Shah, M.D.
• Hinal Shah, PHARM.D
• Jighna Shah, PHARMD
• Kari An Shandley, D.C.

• Psychiatric/Mental Health Nurse Practitioner in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.