Healthcare Provider Details

I. General information

NPI: 1346174430
Provider Name (Legal Business Name): CHANDANA NAMBURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BOSQUE BLVD STE 200
WACO TX
76710-4676
US

IV. Provider business mailing address

4701 LAKELAND DR APT 33H
FLOWOOD MS
39232-9785
US

V. Phone/Fax

Practice location:
  • Phone: 254-261-6363
  • Fax:
Mailing address:
  • Phone: 469-430-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: