Provider Demographics
NPI:1740449396
Name:YANGALASETTY, CHANDRA SEKHAR (MD)
Entity type:Individual
Prefix:
First Name:CHANDRA SEKHAR
Middle Name:
Last Name:YANGALASETTY
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:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0843
Mailing Address - Country:US
Mailing Address - Phone:575-356-6695
Mailing Address - Fax:575-356-5948
Practice Address - Street 1:200 W WILSHIRE, SUITE A
Practice Address - Street 2:LA CASA FAMILY HEALTH CENTER/LOS NINOS PEDIATRICS
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-622-5956
Practice Address - Fax:575-622-4059
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11251208000000X
NMMD2011-0534208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics