Provider Demographics
NPI:1154386514
Name:CHANDRA, SHAKUNTALA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAKUNTALA
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAKUNTALA
Other - Middle Name:
Other - Last Name:NANJUNDASWAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9 PINE MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2457
Mailing Address - Country:US
Mailing Address - Phone:732-940-1362
Mailing Address - Fax:
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:732-249-9572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA713292080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ05387527OtherECFMG/ISSUED 3/22/96
NJ0033383Medicaid