Healthcare Provider Details

I. General information

NPI: 1609960285
Provider Name (Legal Business Name): LYANA DOTY NECHYBA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

6808 CLEAR MEADOW CT
RALEIGH NC
27615-5228
US

V. Phone/Fax

Practice location:
  • Phone: 919-847-2157
  • Fax:
Mailing address:
  • Phone: 919-847-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3170
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3170
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3170
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: