Provider Demographics
NPI:1316020621
Name:FENDYA, JENNIFER ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:FENDYA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 ELMWOOD AVE
Mailing Address - Street 2:#275
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2202
Mailing Address - Country:US
Mailing Address - Phone:888-902-9614
Mailing Address - Fax:
Practice Address - Street 1:408 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1525
Practice Address - Country:US
Practice Address - Phone:888-902-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0140091103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026139501OtherUNIVERA
NY6110998OtherINDEPENDENT HEALTH
000525805004OtherBLUE CROSS BLUE SHIELD
BB7657Medicare ID - Type Unspecified