Provider Demographics
NPI:1508151499
Name:JANDHYALA, CHANAKYA KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:CHANAKYA
Middle Name:KUMAR
Last Name:JANDHYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 TRAP FALLS RD STE 404
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-7622
Mailing Address - Country:US
Mailing Address - Phone:203-734-7900
Mailing Address - Fax:203-513-3269
Practice Address - Street 1:2 TRAP FALLS RD STE 404
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-7622
Practice Address - Country:US
Practice Address - Phone:203-734-7900
Practice Address - Fax:203-513-3269
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287826-1207XS0117X
TXBP10039661207X00000X
CT60101207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery