Provider Demographics
NPI:1114395902
Name:GWANDURE, SIENA
Entity Type:Individual
Prefix:
First Name:SIENA
Middle Name:
Last Name:GWANDURE
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 1:7710 JAMESTOWN NORTH DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1942
Mailing Address - Country:US
Mailing Address - Phone:847-845-7704
Mailing Address - Fax:
Practice Address - Street 1:7710 JAMESTOWN NORTH DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1942
Practice Address - Country:US
Practice Address - Phone:847-845-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002938225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation