Provider Demographics
NPI:1922846377
Name:VANDELL, DYLAN PHILIP
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:PHILIP
Last Name:VANDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 WOODCREEK LN
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2149
Mailing Address - Country:US
Mailing Address - Phone:248-872-5495
Mailing Address - Fax:
Practice Address - Street 1:1450 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6108
Practice Address - Country:US
Practice Address - Phone:248-969-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator