MEDICARE: SIDNEY 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	5453	HI
3	171M00000X	Case Manager/Care Coordinator		HI

General Provider Information

NPI Number	:	1053140525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY BANDY

Provider Business Mailing Address
First Line	:	4856 E EHA WAY
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3012
Country	:	US
Telephone Number	:	757-778-7095
Fax Number	:

Provider Business Practice Location Address
First Line	:	4856 E EHA WAY
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3012
Country	:	US
Telephone Number	:	757-778-7095
Fax Number	:

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

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	01/07/2026

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Directions to “ SIDNEY BANDY ” Practice Location

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