Healthcare Provider Details

I. General information

NPI: 1922792043
Provider Name (Legal Business Name): NADYA SIDKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20555 PROSPECT RD
CUPERTINO CA
95014-5212
US

IV. Provider business mailing address

655 S FAIR OAKS AVE APT B110
SUNNYVALE CA
94086-7808
US

V. Phone/Fax

Practice location:
  • Phone: 659-319-5550
  • Fax:
Mailing address:
  • Phone: 650-531-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: