Healthcare Provider Details

I. General information

NPI: 1740583566
Provider Name (Legal Business Name): MAYSOFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 NE 100TH ST STE 402
SEATTLE WA
98125-8012
US

IV. Provider business mailing address

1597 25TH AVE NE
ISSAQUAH WA
98029-2623
US

V. Phone/Fax

Practice location:
  • Phone: 425-405-5680
  • Fax:
Mailing address:
  • Phone: 425-405-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00049049
License Number StateWA

VIII. Authorized Official

Name: DR. NIRIKSHA MALLADI
Title or Position: OWNER
Credential: M.D.
Phone: 425-405-5680