Provider Demographics
NPI:1679303564
Name:FAYNATO, SISAY
Entity type:Individual
Prefix:
First Name:SISAY
Middle Name:
Last Name:FAYNATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 200TH ST SW STE J
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6606
Mailing Address - Country:US
Mailing Address - Phone:425-263-6341
Mailing Address - Fax:425-678-8457
Practice Address - Street 1:4610 200TH ST SW STE J
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6606
Practice Address - Country:US
Practice Address - Phone:425-263-6341
Practice Address - Fax:425-678-8457
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61572832363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health