Provider Demographics
NPI:1356648935
Name:VANDA, NKOKOTA (BS)
Entity Type:Individual
Prefix:
First Name:NKOKOTA
Middle Name:
Last Name:VANDA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:VANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:207 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-2033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2940
Practice Address - Country:US
Practice Address - Phone:412-243-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst