Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 29340 | AZ |
N | 2080A0000X | Adolescent Medicine | 29340 | AZ |
NPI | 1104824531 |
---|---|
Provider Name | Dr. Sudha Chandrasekhar |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Chandler, AZ 85224-6183 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2005 |
Last Update Date | 21/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G30745 | (02) | AZ |