Provider Demographics
NPI:1386156636
Name:TANDY, MARY L
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:TANDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29155 NORTHWESTERN HWY # 623
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1011
Mailing Address - Country:US
Mailing Address - Phone:248-469-3713
Mailing Address - Fax:
Practice Address - Street 1:20701 DAMMAN ST # 623
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1773
Practice Address - Country:US
Practice Address - Phone:248-469-3713
Practice Address - Fax:248-469-3713
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No251E00000XAgenciesHome Health
No347E00000XTransportation ServicesTransportation Broker