Provider Demographics
NPI:1538187836
Name:TOOR, NADIA W (PHD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:W
Last Name:TOOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:T
Other - Last Name:WASYLYSHYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 79137
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0137
Mailing Address - Country:US
Mailing Address - Phone:757-668-7200
Mailing Address - Fax:757-668-9691
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-668-7247
Practice Address - Fax:757-668-8288
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007708742Medicaid
R65155Medicare UPIN
VA680001161Medicare ID - Type Unspecified