Provider Demographics
NPI:1871769596
Name:VENDRYES, DIANE M (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:VENDRYES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7839
Mailing Address - Country:US
Mailing Address - Phone:850-526-3314
Mailing Address - Fax:850-526-5022
Practice Address - Street 1:4719 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7839
Practice Address - Country:US
Practice Address - Phone:850-526-3314
Practice Address - Fax:850-526-5022
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003128103TC0700X
FLPY7359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical