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General NPI Number Information
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NPI Number | 1487932398
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Entity Type | Individual
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Provider Name | SIDDHARTHA HARISH KRISHNA DEVARAKONDA MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 1221 MADISON ST FL 2
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City | SEATTLE
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State | WA
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Zip | 98104-3588
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Country | US
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Telephone | 206-386-2323
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Fax | 206-215-6165
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Provider Business Mailing Address
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Address Line | PO BOX 25608
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City | SALT LAKE CITY
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State | UT
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Zip | 84125-0608
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Country | US
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Telephone | 206-320-4476
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Fax | 206-568-7043
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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 | 2014039433
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 2014039433
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 2014039433
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | MD61372698
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License Number State | WA
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