Provider Demographics
NPI:1588129571
Name:BESHARA, NANCY (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:BESHARA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 DOUGLAS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3850
Mailing Address - Country:US
Mailing Address - Phone:279-800-7970
Mailing Address - Fax:
Practice Address - Street 1:9272 LAGUNA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7947
Practice Address - Country:US
Practice Address - Phone:279-800-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00543900103T00000X
NY021975103T00000X
CA32041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist