Provider Demographics
NPI:1497150676
Name:TANDY, AMANDA (EDS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:TANDY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5892
Mailing Address - Country:US
Mailing Address - Phone:330-577-3149
Mailing Address - Fax:
Practice Address - Street 1:2141 LAUREL LN
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5892
Practice Address - Country:US
Practice Address - Phone:330-577-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1285747103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool