Provider Demographics
NPI:1881763886
Name:BANDARI, VIJAYALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:BANDARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIJAYALAKSHMI
Other - Middle Name:
Other - Last Name:DONTHINENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:747 BROADWAY
Mailing Address - Street 2:SWEDISH FIRST HILL / CHERRY HILL
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4379
Mailing Address - Country:US
Mailing Address - Phone:206-386-2202
Mailing Address - Fax:206-386-6612
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-652-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042927207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine