Healthcare Provider Details

I. General information

NPI: 1497979348
Provider Name (Legal Business Name): SANDY BUMGARDNER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 GERMANTOWN AVE
PHILADELPHIA PA
19118-2608
US

IV. Provider business mailing address

452 ROSIE LN
HATFIELD PA
19440-1245
US

V. Phone/Fax

Practice location:
  • Phone: 215-348-7104
  • Fax:
Mailing address:
  • Phone: 215-997-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSO15718
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: