Provider Demographics
NPI:1801769799
Name:JOHNSON, NADAYSHA ALIZE
Entity type:Individual
Prefix:
First Name:NADAYSHA
Middle Name:ALIZE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WOODLAWN AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2965
Mailing Address - Country:US
Mailing Address - Phone:203-864-0995
Mailing Address - Fax:
Practice Address - Street 1:450 WOODLAWN AVENUE EXT
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2965
Practice Address - Country:US
Practice Address - Phone:203-864-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician