Provider Demographics
NPI:1912086828
Name:BANDUCCI, MICHELLE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:BANDUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 ANNABEL LN STE 214
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4360
Mailing Address - Country:US
Mailing Address - Phone:925-264-4069
Mailing Address - Fax:925-277-1116
Practice Address - Street 1:3 CROW CANYON COURT
Practice Address - Street 2:SUITE #150
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-362-3861
Practice Address - Fax:925-362-3904
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA760082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry