Provider Demographics
NPI:1598240178
Name:ZIYADHYATT, ZAKIYYAH JOHNICE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ZAKIYYAH
Middle Name:JOHNICE
Last Name:ZIYADHYATT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ZANKER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1129
Mailing Address - Country:US
Mailing Address - Phone:408-590-8655
Mailing Address - Fax:
Practice Address - Street 1:1650 ZANKER RD STE 230
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1129
Practice Address - Country:US
Practice Address - Phone:408-590-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP2500X
CA117679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YP2500XMedicaid
CA405300000XMedicaid
CA103T00000XMedicaid
CA103TE1000XMedicaid
CA101YM0800XMedicaid