Healthcare Provider Details

I. General information

NPI: 1902770423
Provider Name (Legal Business Name): MS. CHANDA MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 GRAND AVE
AMES IA
50010-6035
US

IV. Provider business mailing address

617 GRAND AVE
AMES IA
50010-6035
US

V. Phone/Fax

Practice location:
  • Phone: 515-348-5109
  • Fax: 515-581-7215
Mailing address:
  • Phone: 515-348-5109
  • Fax: 515-581-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: