Healthcare Provider Details

I. General information

NPI: 1235896994
Provider Name (Legal Business Name): NADEJDA ALEXANDROVA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADIA ALEXANDROVA PSYD

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 32ND ST
PHOENIX AZ
85008-6205
US

IV. Provider business mailing address

400 N 32ND ST
PHOENIX AZ
85008-6205
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-7147
  • Fax:
Mailing address:
  • Phone: 602-234-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-005815
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number111116
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: