Healthcare Provider Details

I. General information

NPI: 1427933464
Provider Name (Legal Business Name): GLADYS CHINYERE OBASI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18930 BOTHELL EVERETT HWY APT A303
BOTHELL WA
98012-5229
US

IV. Provider business mailing address

18930 BOTHELL EVERETT HWY APT A303
BOTHELL WA
98012-5229
US

V. Phone/Fax

Practice location:
  • Phone: 425-725-8865
  • Fax:
Mailing address:
  • Phone: 425-725-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number000000
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000000
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: