Provider Demographics
NPI:1922792043
Name:SIDKI, NADYA
Entity Type:Individual
Prefix:
First Name:NADYA
Middle Name:
Last Name:SIDKI
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 1:535 EVERETT AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1515
Mailing Address - Country:US
Mailing Address - Phone:650-531-9993
Mailing Address - Fax:
Practice Address - Street 1:815 ALLERTON ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1360
Practice Address - Country:US
Practice Address - Phone:650-385-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-63171103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst