Provider Demographics
NPI:1477752756
Name:BANDA, TANYA YVETTE (BS)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:YVETTE
Last Name:BANDA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 VANADIUM RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1477
Mailing Address - Country:US
Mailing Address - Phone:412-407-2665
Mailing Address - Fax:
Practice Address - Street 1:363 VANADIUM RD STE 105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1477
Practice Address - Country:US
Practice Address - Phone:412-407-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical