Provider Demographics
NPI:1821023995
Name:KANTOR, CHANDRA DEVI JAYA (ARNP)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:DEVI JAYA
Last Name:KANTOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 7TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-770-2664
Mailing Address - Fax:772-770-3506
Practice Address - Street 1:3715 7TH TER
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6571
Practice Address - Country:US
Practice Address - Phone:772-770-2664
Practice Address - Fax:772-770-3506
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2173832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303173000Medicaid
FL303173000Medicaid
R61374Medicare UPIN