Provider Demographics
NPI:1003284878
Name:BANDELE, ANTHONY D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:D
Last Name:BANDELE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:D
Other - Last Name:BANDELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1467 S JASPER ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4028
Mailing Address - Country:US
Mailing Address - Phone:303-921-3633
Mailing Address - Fax:
Practice Address - Street 1:2323 S TROY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1946
Practice Address - Country:US
Practice Address - Phone:303-921-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1387103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist