MEDICARE: CHANDRA WADDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	2101002176	VA

General Provider Information

NPI Number	:	1871020487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA WADDY

Provider Business Mailing Address
First Line	:	750 N COMMONS DR STE 200
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7940
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	3610 FESTIVAL PARK PLZ STE A
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-4422
Country	:	US
Telephone Number	:	804-796-3210
Fax Number	:	804-796-1112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	06/13/2022

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