Provider Demographics
NPI:1902022775
Name:BINTASAN, SUNIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNIDA
Middle Name:
Last Name:BINTASAN
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 1:1615 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2120
Mailing Address - Country:US
Mailing Address - Phone:206-228-5020
Mailing Address - Fax:206-325-5020
Practice Address - Street 1:500 S 336TH ST STE 213
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6478
Practice Address - Country:US
Practice Address - Phone:206-995-0727
Practice Address - Fax:206-325-5020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000214072084P0800X
WA214072084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1422058Medicaid