Individual
ANDREA M FASULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
33501 1ST WAY S, FEDERAL WAY, WA 98003-6208
(253) 838-2400
Mailing address
1100 OLIVE WAY MSC M4-PA, SEATTLE, WA 98101-1873
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00036355
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039577
LABOR & INDUSTRY
WA
05
—
8232092
—
WA
01
—
MA9229
BLUE SHIELD
WA
01
—
US1037387
AETNA/USHC SPECIALIST
WA
Enumeration date
07/12/2006
Last updated
04/10/2008
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