Provider Demographics
NPI:1760406904
Name:KODE, SHUBHADA K (MD)
Entity Type:Individual
Prefix:
First Name:SHUBHADA
Middle Name:K
Last Name:KODE
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 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11695 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5268
Practice Address - Country:US
Practice Address - Phone:425-637-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000209492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0163635OtherLABOR & INDUSTRY
WA1046754Medicaid
WAUS0862144OtherAETNA/USHC SPECIALIST
WA260046443OtherRAILROAD MEDICARE
WAKO5663OtherBLUE SHIELD
WA0163635OtherLABOR & INDUSTRY
WA1046754Medicaid
WAG8887631Medicare PIN
WA000182512Medicare PIN