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1912265760

NPI Code Detail

MEDICARE: SUSHITHA SURENDRAN MD

MEDICARE: SUSHITHA SURENDRAN MD

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	2080P0202X	Pediatric Cardiology Physician	24976	MS
2	208000000X	Pediatrics Physician	U5312	TX
3	2080P0202X	Pediatric Cardiology Physician	MD61232884	WA
4	2080P0202X	Pediatric Cardiology Physician	U5312	TX

General Provider Information

NPI Number	:	1912265760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSHITHA SURENDRAN MD

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	TOPPENISH
State	:	WA
Zip	:	98948-0190
Country	:	US
Telephone Number	:	509-865-2395
Fax Number	:	509-865-0757

Provider Business Practice Location Address
First Line	:	4011 TALBOT RD S STE 500
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5782
Country	:	US
Telephone Number	:	425-690-3482
Fax Number	:	425-690-9082

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	12/24/2025

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1437269974 — HAMILTON S GILLESPIE MD
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1568751154 — GURPREET SINGH JOHAL M.D
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Directions to “ SUSHITHA SURENDRAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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