Provider Demographics
NPI:1710165121
Name:RAZZHAVAIKINA, TATSIANA I (PHD)
Entity Type:Individual
Prefix:DR
First Name:TATSIANA
Middle Name:I
Last Name:RAZZHAVAIKINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:I
Other - Last Name:RAZZHAVAIKINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:8873 E 29TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2827
Mailing Address - Country:US
Mailing Address - Phone:402-770-3895
Mailing Address - Fax:
Practice Address - Street 1:8873 E 29TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2827
Practice Address - Country:US
Practice Address - Phone:402-770-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025654200Medicaid