Provider Demographics
NPI:1720510449
Name:VADDAMANI, TANUJA
Entity type:Individual
Prefix:
First Name:TANUJA
Middle Name:
Last Name:VADDAMANI
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 1:5505 COPPERRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3137
Mailing Address - Country:US
Mailing Address - Phone:989-708-1710
Mailing Address - Fax:
Practice Address - Street 1:337 LEMKE ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-5926
Practice Address - Country:US
Practice Address - Phone:989-708-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician