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General NPI Number Information
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NPI Number | 1053340885
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Entity Type | Individual
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Provider Name | SHAISTA QUDDUSI MD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 700 S 320TH ST SUITE D
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City | FEDERAL WAY
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State | WA
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Zip | 98003-4691
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Country | US
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Telephone | 253-880-1029
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Fax |
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Provider Business Mailing Address
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Address Line | 700 S 320TH ST, ADVANCED DIABETES & ENDOCRINE CARE SUITE D
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City | FEDERAL WAY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 253-880-1029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00032808
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD00032808
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License Number State | WA
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