Provider Demographics
NPI:1730738428
Name:CHANDROTH, DALIYA ANOO
Entity type:Individual
Prefix:
First Name:DALIYA
Middle Name:ANOO
Last Name:CHANDROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-01 BROADWAY STE 24
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6006
Mailing Address - Country:US
Mailing Address - Phone:201-410-8370
Mailing Address - Fax:833-325-6766
Practice Address - Street 1:15-01 BROADWAY STE 24
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6006
Practice Address - Country:US
Practice Address - Phone:201-410-8370
Practice Address - Fax:833-325-6766
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402815-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health