Provider Demographics
NPI:1679378103
Name:ALSANADY, LIDYA
Entity type:Individual
Prefix:
First Name:LIDYA
Middle Name:
Last Name:ALSANADY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31373 BRAE BURN AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-7625
Mailing Address - Country:US
Mailing Address - Phone:510-386-8435
Mailing Address - Fax:
Practice Address - Street 1:2601 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5246
Practice Address - Country:US
Practice Address - Phone:510-793-7492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95128819163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool