Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1387 | CO |
Y | 103T00000X | Psychologist | 1387 | CO |
NPI | 1003284878 |
---|---|
Provider Name | Dr. Anthony D Bandele |
First Address | Aurora, CO 80017-4028 |
Second Address | Aurora, CO 80014-1946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2015 |
Last Update Date | 09/09/2015 |