Provider Demographics
NPI:1538410279
Name:JASTRZEMBSKI, NISHA KAGAL (MA)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:KAGAL
Last Name:JASTRZEMBSKI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NISHA
Other - Middle Name:SHYAM
Other - Last Name:KAGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:684 ROBERTSON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:684 ROBERTSON WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-3650
Practice Address - Country:US
Practice Address - Phone:617-356-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9541101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health