Provider Demographics
NPI:1689045791
Name:ANISHCHENKO, ANASTASIA (PSYD)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:ANISHCHENKO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANASTACIA
Other - Middle Name:
Other - Last Name:ANISHCHENKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:845 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4807
Mailing Address - Country:US
Mailing Address - Phone:650-762-8352
Mailing Address - Fax:
Practice Address - Street 1:845 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4807
Practice Address - Country:US
Practice Address - Phone:650-762-8352
Practice Address - Fax:188-896-5057
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35384103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist