Healthcare Provider Details

I. General information

NPI: 1942147343
Provider Name (Legal Business Name): SHAVANYA SIDNEY M.S.PSY, BCPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAY SIDNEY M.S.PSY, BCPA

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE 6548
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE 6548
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 623-260-2084
  • Fax:
Mailing address:
  • Phone: 623-260-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: