Provider Demographics
NPI:1568916732
Name:MANDAVIA, WAHAJ (BCBA)
Entity Type:Individual
Prefix:
First Name:WAHAJ
Middle Name:
Last Name:MANDAVIA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 MAHOGANY LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-1285
Mailing Address - Country:US
Mailing Address - Phone:469-734-2337
Mailing Address - Fax:
Practice Address - Street 1:9300 JOHN HICKMAN PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5711
Practice Address - Country:US
Practice Address - Phone:469-734-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-29433103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst