=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912853284
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIMRAN CHANDAWARKAR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2026
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4209 STATE ROUTE 44
-----------------------------------------------------
City | ROOTSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44272-9698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-993-3420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5118 CLARIDGE DR
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43054-9480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------