Provider Demographics
NPI:1962546812
Name:AGRO, CHANDA GAIL (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHANDA
Middle Name:GAIL
Last Name:AGRO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WHITE CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2465
Mailing Address - Country:US
Mailing Address - Phone:716-689-6263
Mailing Address - Fax:716-885-9201
Practice Address - Street 1:173 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1152
Practice Address - Country:US
Practice Address - Phone:716-885-9200
Practice Address - Fax:716-885-9201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY516958163W00000X
NY333774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily