Healthcare Provider Details

I. General information

NPI: 1518258946
Provider Name (Legal Business Name): MAYSOFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15436 BEL RED RD SUITE 100
REDMOND WA
98052-5536
US

IV. Provider business mailing address

1597 25TH AVE NE
ISSAQUAH WA
98029-2623
US

V. Phone/Fax

Practice location:
  • Phone: 425-562-2237
  • Fax: 425-562-2236
Mailing address:
  • Phone: 917-420-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD00049049
License Number StateWA

VIII. Authorized Official

Name: DR. NIRIKSHA MALLADI
Title or Position: SECRETARY
Credential: MD
Phone: 917-420-3540