Provider Demographics
NPI:1184009896
Name:CHANDRA, PALLAVI
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:CHANDRA
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 1:321 BRIDGEFORD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6677
Mailing Address - Country:US
Mailing Address - Phone:513-310-1344
Mailing Address - Fax:
Practice Address - Street 1:3111 SACBE CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7520
Practice Address - Country:US
Practice Address - Phone:513-310-1344
Practice Address - Fax:737-277-5585
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1653103K00000X
TX117047225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst