Provider Demographics
NPI:1265612410
Name:ROSENBLEDT, NANCY SUE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SUE
Last Name:ROSENBLEDT
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 1:272 BONITA LANE
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404
Mailing Address - Country:US
Mailing Address - Phone:650-576-3087
Mailing Address - Fax:
Practice Address - Street 1:1740 MARCO POLO WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4522
Practice Address - Country:US
Practice Address - Phone:650-576-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist