Provider Demographics
NPI:1164787693
Name:SANDUSKY, PAUL DERYN (BA, CCDP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DERYN
Last Name:SANDUSKY
Suffix:
Gender:M
Credentials:BA, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 PENN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1768
Mailing Address - Country:US
Mailing Address - Phone:412-721-0690
Mailing Address - Fax:412-688-9191
Practice Address - Street 1:5231 PENN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1768
Practice Address - Country:US
Practice Address - Phone:412-721-0690
Practice Address - Fax:412-688-9191
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor