=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245724475
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. TULASI KHANDAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2018
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 ADELBERT RD STE 170
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44106-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-249-6341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 UNIVERSITY DR
-----------------------------------------------------
City | HERSHEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17033-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-243-1455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number | 35.151607
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------