Provider Demographics
NPI:1679359921
Name:BENDOLPH, TYVARIA
Entity type:Individual
Prefix:
First Name:TYVARIA
Middle Name:
Last Name:BENDOLPH
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 1:4415 AMHURST DR
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-3317
Mailing Address - Country:US
Mailing Address - Phone:251-725-2686
Mailing Address - Fax:
Practice Address - Street 1:4415 AMHURST DR
Practice Address - Street 2:
Practice Address - City:EIGHT MILE
Practice Address - State:AL
Practice Address - Zip Code:36613-3317
Practice Address - Country:US
Practice Address - Phone:251-725-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program