Healthcare Provider Details

I. General information

NPI: 1710272067
Provider Name (Legal Business Name): XANDUS CHEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD
LUTZ FL
33558-8005
US

IV. Provider business mailing address

2502 W SAINT ISABEL ST
TAMPA FL
33607-6318
US

V. Phone/Fax

Practice location:
  • Phone: 813-874-5707
  • Fax: 813-874-5908
Mailing address:
  • Phone: 813-874-5707
  • Fax: 813-874-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS13064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: