Healthcare Provider Details

I. General information

NPI: 1417651621
Provider Name (Legal Business Name): VANDANA CHAUDHARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ADELBERT RD
CLEVELAND OH
44106-2624
US

IV. Provider business mailing address

2101 ADELBERT RD
CLEVELAND OH
44106-2624
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3911
  • Fax:
Mailing address:
  • Phone: 216-844-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.018527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: