Provider Demographics
NPI:1851766257
Name:BANDI, DEBRA CELRI (LMP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:CELRI
Last Name:BANDI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15626 161ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8931
Mailing Address - Country:US
Mailing Address - Phone:323-610-2610
Mailing Address - Fax:
Practice Address - Street 1:17416 SR 9 STE B
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-6304
Practice Address - Country:US
Practice Address - Phone:360-668-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003571225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist