Provider Demographics
NPI:1992522429
Name:IYANDA, MATTHEW A (MS PHD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:IYANDA
Suffix:
Gender:M
Credentials:MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CONACH LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-3984
Mailing Address - Country:US
Mailing Address - Phone:817-877-6989
Mailing Address - Fax:
Practice Address - Street 1:3618 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-5190
Practice Address - Country:US
Practice Address - Phone:302-725-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)