Healthcare Provider Details

I. General information

NPI: 1912853284
Provider Name (Legal Business Name): SIMRAN CHANDAWARKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 STATE ROUTE 44
ROOTSTOWN OH
44272-9698
US

IV. Provider business mailing address

5118 CLARIDGE DR
NEW ALBANY OH
43054-9480
US

V. Phone/Fax

Practice location:
  • Phone: 860-993-3420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: