Provider Demographics
NPI:1508153230
Name:BANDI, BETHANY JOY (PA-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:BANDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:H50
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-3176
Mailing Address - Country:US
Mailing Address - Phone:216-444-4486
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:H50
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3176
Practice Address - Country:US
Practice Address - Phone:216-444-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003191363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH019400Medicare PIN