Provider Demographics
NPI:1275516395
Name:CHANDRAKANT, VIJAYA LAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:LAKSHMI
Last Name:CHANDRAKANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1468 RICHMOND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1550
Mailing Address - Country:US
Mailing Address - Phone:718-982-8922
Mailing Address - Fax:718-982-9063
Practice Address - Street 1:1468 RICHMOND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1550
Practice Address - Country:US
Practice Address - Phone:718-982-8922
Practice Address - Fax:718-982-9063
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00480075Medicaid
NYB14714Medicare UPIN