Provider Demographics
NPI:1003995655
Name:PANGANAMALA-ZINNBAUER, NANCY (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:PANGANAMALA-ZINNBAUER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:RAO
Other - Last Name:PANGANAMALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:9403 KENWOOD ROAD
Mailing Address - Street 2:SUITE D112
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6820
Mailing Address - Country:US
Mailing Address - Phone:513-860-0801
Mailing Address - Fax:
Practice Address - Street 1:9403 KENWOOD ROAD
Practice Address - Street 2:SUITE D112
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6820
Practice Address - Country:US
Practice Address - Phone:513-793-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH5620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical