Provider Demographics
NPI:1992510259
Name:BANDA, JENNIFER (CSFA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BANDA
Suffix:
Gender:
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16193 W DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5749
Mailing Address - Country:US
Mailing Address - Phone:602-918-4351
Mailing Address - Fax:
Practice Address - Street 1:16193 W DAVIS RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5749
Practice Address - Country:US
Practice Address - Phone:602-918-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty