Provider Demographics
NPI:1609482637
Name:MALEKI, SEPIDEH
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:MALEKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 LARCH WAY UNIT Z102
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-8134
Mailing Address - Country:US
Mailing Address - Phone:425-245-4645
Mailing Address - Fax:
Practice Address - Street 1:16520 LARCH WAY UNIT Z102
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8134
Practice Address - Country:US
Practice Address - Phone:425-245-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA201193248Medicaid
WA201193248WAMedicaid