Provider Demographics
NPI:1871774133
Name:TANDY, STEPHANY LEIGH (MS, GC)
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:LEIGH
Last Name:TANDY
Suffix:
Gender:F
Credentials:MS, GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E MANFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4847
Mailing Address - Country:US
Mailing Address - Phone:317-374-9049
Mailing Address - Fax:909-427-2654
Practice Address - Street 1:9985 SIERRA AVE
Practice Address - Street 2:MOB2, 2ND FLOOR, MODULE 2A
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-2431
Practice Address - Fax:909-427-2654
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS