Provider Demographics
NPI:1548254857
Name:CHANDRAHASA, USHA (MD)
Entity type:Individual
Prefix:MRS
First Name:USHA
Middle Name:
Last Name:CHANDRAHASA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:3400 TAMIAMI TRL
Practice Address - Street 2:STE 201
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-743-2277
Practice Address - Fax:941-743-2275
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84695207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17055OtherBCBS FL
FL17055OtherBCBS FL
FL17055Medicare ID - Type Unspecified
H69109Medicare UPIN