Provider Demographics
NPI:1235896994
Name:ALEXANDROVA, NADEJDA (PSYD)
Entity Type:Individual
Prefix:
First Name:NADEJDA
Middle Name:
Last Name:ALEXANDROVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:
Other - Last Name:ALEXANDROVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:5620 S CROWS NEST RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2111
Mailing Address - Country:US
Mailing Address - Phone:408-702-0818
Mailing Address - Fax:
Practice Address - Street 1:5040 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3328
Practice Address - Country:US
Practice Address - Phone:408-702-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty