Provider Demographics
NPI:1881036457
Name:YELLINEDI, CHANDRA (MS)
Entity Type:Individual
Prefix:MR
First Name:CHANDRA
Middle Name:
Last Name:YELLINEDI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRAZER FIR RD
Mailing Address - Street 2:55 FRAZIER FIR ROAD
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1653
Mailing Address - Country:US
Mailing Address - Phone:860-841-7908
Mailing Address - Fax:
Practice Address - Street 1:55 FRAZER FIR
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074
Practice Address - Country:US
Practice Address - Phone:860-841-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0011229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist