Healthcare Provider Details

I. General information

NPI: 1568182814
Provider Name (Legal Business Name): GANDIS G MAZEIKA MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 10/12/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21701 76TH AVE W STE 206
EDMONDS WA
98026-7536
US

IV. Provider business mailing address

16150 NE 85TH ST STE 203
REDMOND WA
98052-3543
US

V. Phone/Fax

Practice location:
  • Phone: 206-427-4242
  • Fax: 425-636-2401
Mailing address:
  • Phone: 206-427-4242
  • Fax: 425-636-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEXANDRA A MAZEIKA
Title or Position: EXECUTIVE DIRECTOR
Credential: JD
Phone: 206-427-4242