Healthcare Provider Details

I. General information

NPI: 1508414194
Provider Name (Legal Business Name): ROCHELLE B SYKES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 N BLACK CANYON HWY STE B140
PHOENIX AZ
85053-4064
US

IV. Provider business mailing address

6542 N 17TH AVE APT 2
PHOENIX AZ
85015-1387
US

V. Phone/Fax

Practice location:
  • Phone: 602-946-8667
  • Fax:
Mailing address:
  • Phone: 602-946-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005775
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: