Healthcare Provider Details

I. General information

NPI: 1770233595
Provider Name (Legal Business Name): NIDHI CHILLARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date: 10/04/2024
Reactivation Date: 12/17/2025

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

6 TOBINS CT FL 3
DANBURY CT
06810-7090
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6240
  • Fax:
Mailing address:
  • Phone: 203-770-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1770233595
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number1770233595
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: