Provider Demographics
NPI:1578091468
Name:BORAD, CHANDANI
Entity Type:Individual
Prefix:
First Name:CHANDANI
Middle Name:
Last Name:BORAD
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 1:30 CRIMSON KING DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2387
Mailing Address - Country:US
Mailing Address - Phone:323-477-2037
Mailing Address - Fax:
Practice Address - Street 1:1859 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1731
Practice Address - Country:US
Practice Address - Phone:732-347-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist