Provider Demographics
NPI:1780274647
Name:SIDDIQI, AMAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMAN
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 8TH ST S STE 471
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1804
Mailing Address - Country:US
Mailing Address - Phone:650-720-7431
Mailing Address - Fax:
Practice Address - Street 1:19 8TH ST S STE 471
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1804
Practice Address - Country:US
Practice Address - Phone:650-720-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06926103T00000X, 103TC0700X, 103TC2200X
ND630103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent