Individual
KUSUMA LATHA SIVALANKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1400 S JACKSON ST, SEATTLE, WA 98144-2020
(206) 568-8577
(206) 568-3385
Mailing address
1400 S JACKSON ST, SEATTLE, WA 98144-2020
(206) 568-8577
(206) 568-3385
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61137144
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952950958
—
WA
Enumeration date
09/11/2019
Last updated
07/17/2026
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