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General NPI Number Information
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NPI Number | 1912265760
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Entity Type | Individual
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Provider Name | SUSHITHA SURENDRAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 4011 TALBOT RD S STE 500
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City | RENTON
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State | WA
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Zip | 98055-5782
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Country | US
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Telephone | 425-690-3482
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Fax | 425-690-9082
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Provider Business Mailing Address
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Address Line | 315 N SAN SABA STE 1135
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City | SAN ANTONIO
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State | TX
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Zip | 78207-3255
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Country | US
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Telephone | 210-704-4275
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | U5312
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 24976
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | U5312
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD61232884
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License Number State | WA
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