Provider Demographics
NPI:1316320278
Name:CHANDRAN, ALYSHA KAYE (NP)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:KAYE
Last Name:CHANDRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:125 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2558
Practice Address - Country:US
Practice Address - Phone:864-482-3000
Practice Address - Fax:864-482-4000
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPENDINGMedicaid
SCSC6310Medicare PIN