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NPI Code Detail

MEDICARE: TERESA WANDAS PHD

MEDICARE: TERESA WANDAS PHD
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
1103T00000XPsychologist015846NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770592107
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA WANDAS PHD
Provider Business Mailing Address
First Line : 50 FLEETWOOD AVE APT 4A
Second Line :
City : MOUNT VERNON
State : NY
Zip : 10552-2864
Country : US
Telephone Number : 914-668-5767
Fax Number :
Provider Business Practice Location Address
First Line : 57 SAINT MARKS PL
Second Line :
City : NEW YORK
State : NY
Zip : 10003-7902
Country : US
Telephone Number : 212-982-3470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/08/2007

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