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NPI Code Detail

MEDICARE: DR. ANDREA SHUNETTE WADDELL-PRATT PH.D.

MEDICARE: DR. ANDREA SHUNETTE WADDELL-PRATT PH.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
1103TC0700XClinical Psychologist3384AZ

General Provider Information

NPI Number : 1598767790
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREA SHUNETTE WADDELL-PRATT PH.D.
Provider Business Mailing Address
First Line : 810 N 6TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85003-1318
Country : US
Telephone Number : 602-462-1115
Fax Number : 602-462-1119
Provider Business Practice Location Address
First Line : 810 N 6TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85003-1318
Country : US
Telephone Number : 602-462-1115
Fax Number : 602-462-1119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/13/2007

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