Provider Demographics
NPI:1700071719
Name:DEBORAH L SANEDA PHD
Entity Type:Organization
Organization Name:DEBORAH L SANEDA PHD
Other - Org Name:PSYCHOLOGY & NEUROPSYCHOLOGY OF SW VA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST/OWNE
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:276-228-2998
Mailing Address - Street 1:430 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2351
Mailing Address - Country:US
Mailing Address - Phone:276-228-2998
Mailing Address - Fax:276-228-2905
Practice Address - Street 1:430 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2351
Practice Address - Country:US
Practice Address - Phone:276-228-2998
Practice Address - Fax:276-228-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty