Provider Demographics
NPI:1144854324
Name:CHANDAK, ANKITA
Entity type:Individual
Prefix:
First Name:ANKITA
Middle Name:
Last Name:CHANDAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 KEYSTONE AVE APT 69
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7132
Mailing Address - Country:US
Mailing Address - Phone:858-736-1901
Mailing Address - Fax:
Practice Address - Street 1:1505 MERIDIAN AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5353
Practice Address - Country:US
Practice Address - Phone:858-736-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty