Provider Demographics
NPI:1538694435
Name:MASON, CHANDRA ANESE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:ANESE
Last Name:MASON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 PORTSIDE LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3615
Mailing Address - Country:US
Mailing Address - Phone:972-754-3502
Mailing Address - Fax:
Practice Address - Street 1:1350 E LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4106
Practice Address - Country:US
Practice Address - Phone:972-220-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211158171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor