Diane Atsidakos

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

7615 Golden Triangle Dr Ste a
Eden Prairie, MN 55344-3733

Phone

(612) 400-6119

NPI assigned

Dec 22, 2020

Last updated

Aug 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1144817313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3527 KADY AVE NE",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553763090",
            "telephone_number": "612-999-0969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7615 GOLDEN TRIANGLE DR STE A",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443733",
            "telephone_number": "612-400-6119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9120 Springbrook Dr NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335845",
            "country_code": "US",
            "telephone_number": "612-767-7222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ATSIDAKOS",
        "first_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-22",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Behavior Analyst in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.