Healthcare Provider Details

I. General information

NPI: 1720375793
Provider Name (Legal Business Name): SUNIL ALEXANDER CHANDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 THOMAS JONES WAY SUITE 304
EXTON PA
19341-2553
US

IV. Provider business mailing address

495 THOMAS JONES WAY SUITE 304
EXTON PA
19341-2553
US

V. Phone/Fax

Practice location:
  • Phone: 484-879-6508
  • Fax: 484-879-6509
Mailing address:
  • Phone: 484-879-6508
  • Fax: 484-879-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number261989
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD440039
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: