Provider Demographics
NPI:1821868282
Name:FANDRAY, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:FANDRAY
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 1:4021 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-3423
Mailing Address - Country:US
Mailing Address - Phone:412-559-2960
Mailing Address - Fax:
Practice Address - Street 1:4021 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-3423
Practice Address - Country:US
Practice Address - Phone:412-559-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program