MEDICARE: MRS. AMANDA TANDY ED.S.

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	103TS0200X	School Psychologist	OH1285747	OH

General Provider Information

NPI Number	:	1497150676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA TANDY ED.S.

Provider Business Mailing Address
First Line	:	2141 LAUREL LN
Second Line	:
City	:	STREETSBORO
State	:	OH
Zip	:	44241-5892
Country	:	US
Telephone Number	:	330-577-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 LAUREL LN
Second Line	:
City	:	STREETSBORO
State	:	OH
Zip	:	44241-5892
Country	:	US
Telephone Number	:	330-577-3149
Fax Number	:

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

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	10/29/2014

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