Provider Demographics
NPI:1104077130
Name:CHANDLER, KHAYRIYYAH ET (DO)
Entity type:Individual
Prefix:DR
First Name:KHAYRIYYAH
Middle Name:ET
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KHAYRIYYAH
Other - Middle Name:ET
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:25A TANNER ST
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2403
Mailing Address - Country:US
Mailing Address - Phone:856-874-8194
Mailing Address - Fax:856-210-7068
Practice Address - Street 1:25A TANNER ST
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2403
Practice Address - Country:US
Practice Address - Phone:856-874-8194
Practice Address - Fax:856-210-7068
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012192390200000X
PAOS015236207Q00000X
NJ25MB09223100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program