Healthcare Provider Details

I. General information

NPI: 1346025194
Provider Name (Legal Business Name): NIRUPAMA CHANDRASHEKARAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22025 NE REDMOND FALL CITY RD
REDMOND WA
98053-8216
US

IV. Provider business mailing address

22025 NE REDMOND FALL CITY RD
REDMOND WA
98053-8216
US

V. Phone/Fax

Practice location:
  • Phone: 425-213-7773
  • Fax:
Mailing address:
  • Phone: 425-213-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.PA.61635497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: