Healthcare Provider Details

I. General information

NPI: 1720945181
Provider Name (Legal Business Name): JADEN CHANDIE NANDKESHWAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 STADIUM WAY DEPT 3903
OGDEN UT
84408-3903
US

IV. Provider business mailing address

3875 STADIUM WAY DEPT 3903
OGDEN UT
84408-3903
US

V. Phone/Fax

Practice location:
  • Phone: 801-626-6000
  • Fax:
Mailing address:
  • Phone: 801-626-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12546575-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: