Provider Demographics
NPI:1063877769
Name:NAIK, SUJATHA (LMP)
Entity type:Individual
Prefix:
First Name:SUJATHA
Middle Name:
Last Name:NAIK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23833 21ST DR SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:425-776-1056
Mailing Address - Fax:425-776-4357
Practice Address - Street 1:23833 21ST DR SE
Practice Address - Street 2:SUITE 203
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9625
Practice Address - Country:US
Practice Address - Phone:425-776-1056
Practice Address - Fax:425-776-4357
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60598348172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker