Healthcare Provider Details

I. General information

NPI: 1275029993
Provider Name (Legal Business Name): UNJALI CHANDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MAIN ST
BUFFALO NY
14214-2635
US

IV. Provider business mailing address

1439 N FOREST RD APT 6
WILLIAMSVILLE NY
14221-2174
US

V. Phone/Fax

Practice location:
  • Phone: 716-200-4122
  • Fax:
Mailing address:
  • Phone: 716-445-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number999999999999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: