Provider Demographics
NPI:1972920486
Name:NAIDU, NIYATHI
Entity type:Individual
Prefix:
First Name:NIYATHI
Middle Name:
Last Name:NAIDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 MILWAUKEE PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 HARRY S TRUMAN DR
Practice Address - Street 2:#32
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-1032
Practice Address - Country:US
Practice Address - Phone:202-562-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool