Provider Demographics
NPI:1942827787
Name:HARRIS, CHANDA DANIELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHANDA
Middle Name:DANIELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 WEEPING CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1566
Mailing Address - Country:US
Mailing Address - Phone:516-509-0553
Mailing Address - Fax:
Practice Address - Street 1:16021 KAIROS RD STE A
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5208
Practice Address - Country:US
Practice Address - Phone:804-526-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily