Healthcare Provider Details

I. General information

NPI: 1285012567
Provider Name (Legal Business Name): NADEJDA BESPALOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 ROOSEVELT WAY NE
SEATTLE WA
98105-6099
US

IV. Provider business mailing address

4225 ROOSEVELT WAY NE
SEATTLE WA
98105-6099
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-7792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60944487
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: