Provider Demographics
NPI:1184797797
Name:CHANDRA, SUSHIL (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COACHLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4229
Mailing Address - Country:US
Mailing Address - Phone:845-452-9118
Mailing Address - Fax:845-849-1169
Practice Address - Street 1:3 COACHLIGHT DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-4229
Practice Address - Country:US
Practice Address - Phone:845-452-9118
Practice Address - Fax:845-849-1169
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1405472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63386Medicare UPIN
NY35J391Medicare ID - Type Unspecified