Provider Demographics
NPI:1053140152
Name:VIDAL PLAZA, SHEYDIE ENELIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHEYDIE
Middle Name:ENELIE
Last Name:VIDAL PLAZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SHEYDIE
Other - Middle Name:
Other - Last Name:VIDAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOCTOR
Mailing Address - Street 1:HC 4 BOX 10578
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-7518
Mailing Address - Country:US
Mailing Address - Phone:939-460-6611
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2 KM. 39.8
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-871-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008071103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical