Healthcare Provider Details

I. General information

NPI: 1679164271
Provider Name (Legal Business Name): SUNDAS PASHA FICK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/03/2022
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUALITY DR
VACAVILLE CA
95688-9494
US

IV. Provider business mailing address

PO BOX 521
SACRAMENTO CA
95812-0521
US

V. Phone/Fax

Practice location:
  • Phone: 707-867-0906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: