Provider Demographics
NPI:1679731624
Name:ATTOTI, CHANDANA (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDANA
Middle Name:
Last Name:ATTOTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1007
Mailing Address - Country:US
Mailing Address - Phone:718-584-0555
Mailing Address - Fax:
Practice Address - Street 1:3184 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1007
Practice Address - Country:US
Practice Address - Phone:718-584-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY263019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program