Provider Demographics
NPI:1992011845
Name:SYEDA, ADIBA ANJUM (MD)
Entity Type:Individual
Prefix:DR
First Name:ADIBA
Middle Name:ANJUM
Last Name:SYEDA
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 1:707 S GRADY WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3227
Mailing Address - Country:US
Mailing Address - Phone:206-823-1004
Mailing Address - Fax:206-309-3319
Practice Address - Street 1:707 S GRADY WAY STE 600
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:206-823-1004
Practice Address - Fax:206-309-3319
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASYEDAAA11111207R00000X
WAMD60500172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine