MEDICARE: NIRUPAMA MADHAVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BA60932675	WA

General Provider Information

NPI Number	:	1487117891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIRUPAMA MADHAVAN

Provider Business Mailing Address
First Line	:	4412 NE 60TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-7604
Country	:	US
Telephone Number	:	425-749-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 25TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105
Country	:	US
Telephone Number	:	206-294-9891
Fax Number	:	844-564-4113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	12/03/2021

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