Provider Demographics
NPI:1932429289
Name:NIDAY, TAKESHIA CAMPBELL (MD)
Entity Type:Individual
Prefix:
First Name:TAKESHIA
Middle Name:CAMPBELL
Last Name:NIDAY
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 1:2760 FIFTH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6325
Mailing Address - Country:US
Mailing Address - Phone:619-500-6566
Mailing Address - Fax:619-374-2982
Practice Address - Street 1:2760 FIFTH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6325
Practice Address - Country:US
Practice Address - Phone:619-500-6566
Practice Address - Fax:619-374-2982
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1135482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry