Healthcare Provider Details

I. General information

NPI: 1750733549
Provider Name (Legal Business Name): CHANTELLE CHAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10624 S EASTERN AVE # A-955
HENDERSON NV
89052-2982
US

IV. Provider business mailing address

10624 S EASTERN AVE # A-955
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-4000
  • Fax:
Mailing address:
  • Phone: 702-255-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19150
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61495837
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: