Provider Demographics
NPI:1679763544
Name:VELAGAPALLI, MINI SPOORTHI SUSHMA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINI SPOORTHI SUSHMA
Middle Name:
Last Name:VELAGAPALLI
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 1:222 112TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5815
Mailing Address - Country:US
Mailing Address - Phone:425-637-1855
Mailing Address - Fax:425-344-7970
Practice Address - Street 1:222 112TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5815
Practice Address - Country:US
Practice Address - Phone:425-637-1855
Practice Address - Fax:425-344-7970
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432327207R00000X
WAMD60250989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1679763544Medicaid
WAP01054370OtherRAILROAD MEDICARE
WA8906869Medicare PIN