Provider Demographics
NPI:1043909633
Name:REECE, CHANDA TAMARA
Entity type:Individual
Prefix:
First Name:CHANDA
Middle Name:TAMARA
Last Name:REECE
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 1:360 STATE ST APT 2310
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3622
Mailing Address - Country:US
Mailing Address - Phone:718-598-7514
Mailing Address - Fax:
Practice Address - Street 1:1093 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1104
Practice Address - Country:US
Practice Address - Phone:860-944-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT169231367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered