Provider Demographics
NPI:1598853426
Name:REDDY, SHAILAJA NM (MD)
Entity Type:Individual
Prefix:
First Name:SHAILAJA
Middle Name:NM
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CARR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5866
Mailing Address - Country:US
Mailing Address - Phone:425-227-3700
Mailing Address - Fax:
Practice Address - Street 1:601 S CARR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5866
Practice Address - Country:US
Practice Address - Phone:425-227-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH&6166Medicare UPIN