Provider Demographics
NPI:1093866972
Name:KHUBCHANDANI, SANJAY NARI (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:NARI
Last Name:KHUBCHANDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 CONROY WINDERMERE RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3565
Mailing Address - Country:US
Mailing Address - Phone:407-438-3557
Mailing Address - Fax:407-438-3558
Practice Address - Street 1:6735 CONROY WINDERMERE RD
Practice Address - Street 2:SUITE 226
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3565
Practice Address - Country:US
Practice Address - Phone:407-438-3557
Practice Address - Fax:407-438-3558
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME977622080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278364900Medicaid