MEDICARE: GRISEL ANDREA BANDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202012383	VA
2	235Z00000X	Speech-Language Pathologist	SP.16186	OH

General Provider Information

NPI Number	:	1740979699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISEL ANDREA BANDY

Provider Business Mailing Address
First Line	:	3570 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5288
Country	:	US
Telephone Number	:	216-402-9358
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5288
Country	:	US
Telephone Number	:	216-402-9358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2023
Last Update Date	:	04/08/2026

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Directions to “ GRISEL ANDREA BANDY ” Practice Location

Language	Start Address	Practice Location

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