Provider Demographics
NPI:1982152757
Name:GAYDUSEK, DIANA
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:GAYDUSEK
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 1:13712 SPRINGSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2365
Mailing Address - Country:US
Mailing Address - Phone:518-369-4723
Mailing Address - Fax:
Practice Address - Street 1:13712 SPRINGSTONE CT
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-2365
Practice Address - Country:US
Practice Address - Phone:703-755-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist