Provider Demographics
NPI:1609817733
Name:HSIEH, S. JUDY (PHD)
Entity type:Individual
Prefix:
First Name:S. JUDY
Middle Name:
Last Name:HSIEH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 ALPINE LILY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3249
Mailing Address - Country:US
Mailing Address - Phone:702-514-6911
Mailing Address - Fax:702-710-1788
Practice Address - Street 1:10521 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3815
Practice Address - Country:US
Practice Address - Phone:702-514-6911
Practice Address - Fax:702-710-1788
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13477103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL134770Medicare ID - Type Unspecified