Provider Demographics
NPI:1477342731
Name:BANCAYAN, ANDREW (SA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BANCAYAN
Suffix:
Gender:
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 HAZEL VISTA LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5397
Mailing Address - Country:US
Mailing Address - Phone:786-382-9042
Mailing Address - Fax:
Practice Address - Street 1:5207 HAZEL VISTA LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5397
Practice Address - Country:US
Practice Address - Phone:786-382-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25-256246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant