Provider Demographics
NPI:1578914842
Name:ASLAN, CHANNDARA THACH (PA-C)
Entity type:Individual
Prefix:
First Name:CHANNDARA
Middle Name:THACH
Last Name:ASLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHANNDARA
Other - Middle Name:
Other - Last Name:THACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 W 117TH ST STE 1238
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-1641
Practice Address - Country:US
Practice Address - Phone:440-840-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059668363A00000X
ALPA 1153363A00000X
SC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant