Healthcare Provider Details

I. General information

NPI: 1558654079
Provider Name (Legal Business Name): JOSHUA KORA CHANDY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7814 N DALE MABRY HWY
TAMPA FL
33614-3220
US

IV. Provider business mailing address

7814 N DALE MABRY HWY
TAMPA FL
33614-3220
US

V. Phone/Fax

Practice location:
  • Phone: 813-405-3938
  • Fax:
Mailing address:
  • Phone: 813-405-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number073523
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS13782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: