Healthcare Provider Details

I. General information

NPI: 1831450287
Provider Name (Legal Business Name): PRIYA CHANDAN MD, PHD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 MEETING ST UNIT 101
PROSPECT KY
40059-5536
US

IV. Provider business mailing address

10503 MEETING ST UNIT 101
PROSPECT KY
40059-5536
US

V. Phone/Fax

Practice location:
  • Phone: 770-605-6054
  • Fax:
Mailing address:
  • Phone: 770-605-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number51857
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number51857
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: