Provider Demographics
NPI:1760798003
Name:GORDY, NASIYA JAE
Entity Type:Individual
Prefix:
First Name:NASIYA
Middle Name:JAE
Last Name:GORDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 ALLSTON WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1833
Mailing Address - Country:US
Mailing Address - Phone:510-845-9071
Mailing Address - Fax:
Practice Address - Street 1:1255 ALLSTON WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1833
Practice Address - Country:US
Practice Address - Phone:510-845-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator