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NPI Code Detail

MEDICARE: BRYAN BANDOW

MEDICARE: BRYAN BANDOW
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
1101Y00000XCounselor
2171M00000XCase Manager/Care Coordinator
3106S00000XBehavior Technician

General Provider Information

NPI Number : 1801594676
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN BANDOW
Provider Business Mailing Address
First Line : 5963 KENTSHIRE DR
Second Line :
City : DAYTON
State : OH
Zip : 45440-4253
Country : US
Telephone Number : 937-952-6379
Fax Number :
Provider Business Practice Location Address
First Line : 452 W MARKET ST
Second Line :
City : XENIA
State : OH
Zip : 45385-2815
Country : US
Telephone Number : 937-376-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 01/23/2026

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Directions to “ BRYAN BANDOW ” Practice Location

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