Provider Demographics
NPI:1558076869
Name:BUNTING, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BUNTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32769 DIONIS DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5859
Mailing Address - Country:US
Mailing Address - Phone:302-381-9378
Mailing Address - Fax:
Practice Address - Street 1:32769 DIONIS DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-5859
Practice Address - Country:US
Practice Address - Phone:302-381-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities