Provider Demographics
NPI:1841232493
Name:CHANDA, JAYASREE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAYASREE
Middle Name:
Last Name:CHANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYASREE
Other - Middle Name:
Other - Last Name:DEBNATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:212 E 106 STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-360-2600
Mailing Address - Fax:646-619-8399
Practice Address - Street 1:212 E 106 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-360-2600
Practice Address - Fax:646-619-8399
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29888174400000X, 207Q00000X, 207V00000X
NY198279207Q00000X
NY198279-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3855243Medicaid
TN4121982OtherTENNCARE SELECT
TN14891OtherTLC FAMILY HEALTHCARE
TN621821584OtherTRICARE
TN6848718OtherCIGNA
TN4121982OtherBLUE CROSS BLUE SHEILD
TN6848718OtherCIGNA
TN3855243Medicaid
TN4121982OtherBLUE CROSS BLUE SHEILD