Healthcare Provider Details

I. General information

NPI: 1760131411
Provider Name (Legal Business Name): ABUNDANT INTEGRATIVE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CEDAR AVE APT 101
SNOHOMISH WA
98290-2959
US

IV. Provider business mailing address

110 CEDAR AVE APT 101
SNOHOMISH WA
98290-2959
US

V. Phone/Fax

Practice location:
  • Phone: 551-208-4093
  • Fax:
Mailing address:
  • Phone: 551-208-4093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. SUDIKSHYA BASKOTA
Title or Position: NATUROPATHIC DOCTOR
Credential: ND
Phone: 360-282-4014