Provider Demographics
NPI:1790872372
Name:CHAKRABORTY, NISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:
Last Name:CHAKRABORTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHENANDA
Other - Middle Name:NISHA
Other - Last Name:NANAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:325 S LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-3693
Mailing Address - Country:US
Mailing Address - Phone:661-725-6266
Mailing Address - Fax:661-725-0407
Practice Address - Street 1:325 S LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3693
Practice Address - Country:US
Practice Address - Phone:661-725-6266
Practice Address - Fax:661-725-0407
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A913140Medicaid