Provider Demographics
NPI:1942403761
Name:KAESEMEYER, NADIYA (MD)
Entity Type:Individual
Prefix:
First Name:NADIYA
Middle Name:
Last Name:KAESEMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7505
Mailing Address - Country:US
Mailing Address - Phone:919-966-1072
Mailing Address - Fax:919-966-0290
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:ROOM 1107G WEST WING
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-1072
Practice Address - Fax:919-966-0290
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141341390200000X
NC2010-019672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program