Provider Demographics
NPI:1821414624
Name:BANDI, KRISTY (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BANDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:REASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-281-1757
Mailing Address - Fax:412-281-7274
Practice Address - Street 1:1307 FEDERAL STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-281-1757
Practice Address - Fax:412-281-7274
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056760363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14023015OtherCAQH
PA103205167Medicaid