Healthcare Provider Details

I. General information

NPI: 1497783500
Provider Name (Legal Business Name): USHARANI V TANDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY RD
MIDDLEBURG HTS OH
44130-3497
US

IV. Provider business mailing address

1610 MENTOR AVE STE 2
PAINSEVILLE OH
44077-1745
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-3119
  • Fax: 208-977-9077
Mailing address:
  • Phone: 440-352-6132
  • Fax: 440-392-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35074966
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35-074966
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: