Provider Demographics
NPI:1679518880
Name:MAZEIKA, GANDIS G (MD)
Entity Type:Individual
Prefix:
First Name:GANDIS
Middle Name:G
Last Name:MAZEIKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 NE 85TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3543
Mailing Address - Country:US
Mailing Address - Phone:206-427-4242
Mailing Address - Fax:425-636-2401
Practice Address - Street 1:21701 76TH AVE W STE 206
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7536
Practice Address - Country:US
Practice Address - Phone:425-636-2400
Practice Address - Fax:425-636-2401
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038659174400000X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1110972Medicaid
WA1110972Medicaid
WAAB36353Medicare ID - Type Unspecified