Provider Demographics
NPI:1558595884
Name:SIDDALINGAPPA, VIJAYA (PHD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:SIDDALINGAPPA
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 1:400 N ASHLEY DR
Mailing Address - Street 2:STE 1625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4300
Mailing Address - Country:US
Mailing Address - Phone:813-289-6597
Mailing Address - Fax:844-587-4802
Practice Address - Street 1:400 N ASHLEY DR
Practice Address - Street 2:STE 1625
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4300
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:844-587-4802
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical