Healthcare Provider Details

I. General information

NPI: 1538293402
Provider Name (Legal Business Name): HIMANSHU CHANDRANA, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 38TH AVE N SUITE 101
ST PETERSBURG FL
33710-1594
US

IV. Provider business mailing address

6450 38TH AVE N SUITE 330
ST PETERSBURG FL
33710-1645
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-8179
  • Fax:
Mailing address:
  • Phone: 727-345-8179
  • Fax: 727-345-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME0044422
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME0044422
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0044422
License Number StateFL

VIII. Authorized Official

Name: HIMANSHU CHANDARANA
Title or Position: PHYSICIAN
Credential: MD
Phone: 727-345-8179