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General NPI Number Information
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NPI Number | 1568483824
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Entity Type | Individual
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Provider Name | SHASHIKANT GORDHANDAS CHANDARANA MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 308 WILLOW AVENUE
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City | HOBOKEN
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State | NJ
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Zip | 07030
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Country | US
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Telephone | 201-418-1820
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Fax | 201-418-1822
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Provider Business Mailing Address
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Address Line | 1126 S 70TH STREET SUITE N500
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City | MILWAUKEE
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State | WI
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Zip | 53214
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Country | US
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Telephone | 414-455-4780
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Fax | 414-475-2936
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA02977700
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License Number State | NJ
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