Healthcare Provider Details

I. General information

NPI: 1598394306
Provider Name (Legal Business Name): ARCHANA CHANDRASHEKAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10238 E HAMPTON AVE STE 205
MESA AZ
85209-3318
US

IV. Provider business mailing address

10238 E HAMPTON AVE STE 205
MESA AZ
85209-3318
US

V. Phone/Fax

Practice location:
  • Phone: 480-907-7551
  • Fax:
Mailing address:
  • Phone: 480-907-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151014382
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number03676494
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number012454
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: