Healthcare Provider Details

I. General information

NPI: 1871437533
Provider Name (Legal Business Name): MS. CHANDAN TIWANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 CARDINAL LANE
GRAND ISLAND NY
14072
US

IV. Provider business mailing address

167 CARDINAL LANE
GRAND ISLAND NY
14072
US

V. Phone/Fax

Practice location:
  • Phone: 716-534-1674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF312692-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: