MEDICARE: DR. SANDY BUMGARDNER PSY.D.

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	103TC0700X	Clinical Psychologist	PSO15718	PA
2	103TS0200X	School Psychologist		PA

General Provider Information

NPI Number	:	1497979348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDY BUMGARDNER PSY.D.

Provider Business Mailing Address
First Line	:	452 ROSIE LN
Second Line	:
City	:	HATFIELD
State	:	PA
Zip	:	19440-1245
Country	:	US
Telephone Number	:	215-997-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2608
Country	:	US
Telephone Number	:	215-348-7104
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	09/11/2025

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