Provider Demographics
NPI:1568483824
Name:CHANDARANA, SHASHIKANT GORDHANDAS (MD)
Entity Type:Individual
Prefix:
First Name:SHASHIKANT
Middle Name:GORDHANDAS
Last Name:CHANDARANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 S 70TH STREET
Mailing Address - Street 2:SUITE N500
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-455-4780
Mailing Address - Fax:414-475-2936
Practice Address - Street 1:308 WILLOW AVENUE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:201-418-1820
Practice Address - Fax:201-418-1822
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA029777002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0943207Medicaid
NJ460583 RAYMedicare PIN
NJC56214Medicare UPIN
NJ670921Medicare UPIN