Provider Demographics
NPI:1841161130
Name:CHANDAKAVADI SHIVANANKARAPPA, NISARGA
Entity type:Individual
Prefix:
First Name:NISARGA
Middle Name:
Last Name:CHANDAKAVADI SHIVANANKARAPPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NISARGA
Other - Middle Name:
Other - Last Name:C SHIVANANKARAPPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:102 MADISON AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7584
Mailing Address - Country:US
Mailing Address - Phone:212-759-2282
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:102 MADISON AVE FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7584
Practice Address - Country:US
Practice Address - Phone:212-759-2282
Practice Address - Fax:212-379-2123
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist