Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD00032808 | WA |
N | 111NI0900X | Internist | MD00032808 | WA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD00032808 | WA |
NPI | 1053340885 |
---|---|
Provider Name | Dr. Shaista Quddusi |
First Address | Federal Way, WA 98003 |
Second Address | Federal Way, WA 98003-4691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 11/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0195405 | L & I (01) | WA |
0205416 | L & I (01) | WA |
04301438 | ECFMG (01) | WA |
8228041 | (05) | WA |
8904723 | CRIME VICTIMS (01) | WA |
8940048 | CRIME VICTIMS (01) | WA |
G67359 | (02) | WA |
P00181501 | RAILROAD (01) | WA |