Provider Demographics
NPI:1083630453
Name:NAYAK, MADHABIKA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:MADHABIKA
Middle Name:B
Last Name:NAYAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1411
Mailing Address - Country:US
Mailing Address - Phone:510-796-7796
Mailing Address - Fax:510-796-7797
Practice Address - Street 1:3755 BEACON AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1411
Practice Address - Country:US
Practice Address - Phone:510-796-7796
Practice Address - Fax:510-796-7797
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical