Healthcare Provider Details

I. General information

NPI: 1215510060
Provider Name (Legal Business Name): SASKIA DEVAUGHN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 VASSAR DR NE
ALBUQUERQUE NM
87106-2727
US

IV. Provider business mailing address

3911 SMITH AVE SE
ALBUQUERQUE NM
87108-4347
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1628
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: