Provider Information for 1972153534
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CHLOE SIDOTI
Sex: Female
NPI: 1972153534
Last Updated: 2019-09-16
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972153534 | ||||||||||||
| Enumeration Date | 2019-09-16 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 414 FRONT ST N ISSAQUAH, WA 98027-2914 United States Phone: 425-392-6367 | Fax: | ||||||||||||
| Primary Practice Address | 414 FRONT ST N ISSAQUAH, WA 98027-2914 United States Phone: 425-392-6367 | Fax: | ||||||||||||
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