Provider Demographics
NPI:1649363151
Name:CHANDRASEKHAR, SUJANA S (MD)
Entity type:Individual
Prefix:DR
First Name:SUJANA
Middle Name:S
Last Name:CHANDRASEKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:18 E 48TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1014
Practice Address - Country:US
Practice Address - Phone:646-868-4300
Practice Address - Fax:646-868-4495
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06045800207YX0901X
NY178192207YX0901X
NY1781921207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1180621OtherAETNA
NYOXFORDOtherP877572
NY8M0242OtherBLUE CROSS BLUE SHEILD
NYN96509OtherHEALTH NET
NYOXFORDOtherP877572
NYG66905Medicare UPIN