Provider Demographics
NPI:1598246530
Name:CHANDRA, MOHINI T
Entity Type:Individual
Prefix:
First Name:MOHINI
Middle Name:T
Last Name:CHANDRA
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 1:25 FARAWAY RD
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1215
Mailing Address - Country:US
Mailing Address - Phone:804-716-6129
Mailing Address - Fax:
Practice Address - Street 1:1900 LAKEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238
Practice Address - Country:US
Practice Address - Phone:804-521-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist