Provider Demographics
NPI:1114915444
Name:CHANDARANA, HIMANSHU V (MD)
Entity Type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:V
Last Name:CHANDARANA
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 1:3380 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1539
Mailing Address - Country:US
Mailing Address - Phone:727-345-8179
Mailing Address - Fax:727-345-7484
Practice Address - Street 1:3380 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1539
Practice Address - Country:US
Practice Address - Phone:727-345-8179
Practice Address - Fax:727-345-7484
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044422207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290001234OtherRAILROAD MEDICARE
FL62541OtherBLUE CROSS & BLUE SHIELD
FL040667800Medicaid
FL040667800Medicaid
FLD-57491Medicare UPIN
FL62541OtherBLUE CROSS & BLUE SHIELD