Healthcare Provider Details

I. General information

NPI: 1003995655
Provider Name (Legal Business Name): NANCY PANGANAMALA-ZINNBAUER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY RAO PANGANAMALA PSYD

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 KENWOOD ROAD SUITE D112
CINCINNATI OH
45242-6820
US

IV. Provider business mailing address

9403 KENWOOD ROAD SUITE D112
CINCINNATI OH
45242-6820
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-3900
  • Fax:
Mailing address:
  • Phone: 513-860-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberOH5620
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: