Provider Demographics
NPI:1982862363
Name:VANANDA, BERYLE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BERYLE
Middle Name:LEE
Last Name:VANANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:427 GUY PARK AVENUE
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1054
Mailing Address - Country:US
Mailing Address - Phone:518-841-7360
Mailing Address - Fax:518-770-7536
Practice Address - Street 1:427 GUY PARK AVENUE
Practice Address - Street 2:BEHAVIORAL HEALTH
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1054
Practice Address - Country:US
Practice Address - Phone:518-841-7360
Practice Address - Fax:518-770-7536
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC149725390200000X
NY2610882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program