Healthcare Provider Details

I. General information

NPI: 1114554870
Provider Name (Legal Business Name): NEHA CHANDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 9TH AVE N STE 100
ST PETERSBURG FL
33713-7147
US

IV. Provider business mailing address

2191 9TH AVE N STE 100
ST PETERSBURG FL
33713-7147
US

V. Phone/Fax

Practice location:
  • Phone: 815-545-2740
  • Fax: 727-493-9945
Mailing address:
  • Phone: 815-545-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME166893
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME166893
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME166893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: