Healthcare Provider Details

I. General information

NPI: 1033798228
Provider Name (Legal Business Name): MAYA GATTUPALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 06/13/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356465
SEATTLE WA
98195-2612
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 356465
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-5207
  • Fax: 206-685-8100
Mailing address:
  • Phone:
  • Fax: 206-685-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOP61666672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: