Provider Demographics
NPI:1922489871
Name:CHANDARANA, JANKI
Entity Type:Individual
Prefix:
First Name:JANKI
Middle Name:
Last Name:CHANDARANA
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 1:625 MOUNT AUBURN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4518
Mailing Address - Country:US
Mailing Address - Phone:174-915-5866
Mailing Address - Fax:617-661-5995
Practice Address - Street 1:625 MOUNT AUBURN ST STE 104
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4518
Practice Address - Country:US
Practice Address - Phone:617-491-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108087207Q00000X
MA1014198207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine