Healthcare Provider Details

I. General information

NPI: 1790718633
Provider Name (Legal Business Name): SIRISHA SESHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 5TH AVE SUITE 301
SPOKANE WA
99204-2823
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-3633
  • Fax: 509-473-3634
Mailing address:
  • Phone: 509-838-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00046558
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: