Provider Demographics
NPI:1487871034
Name:SCIANDRA, JODI ANN (PSYD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:SCIANDRA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:480-684-5041
Mailing Address - Fax:
Practice Address - Street 1:1920 N HIGLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1623
Practice Address - Country:US
Practice Address - Phone:480-543-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z120242Medicare PIN