Individual provider Active NPI

Alicia Chanda, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1174405740
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F407118-01 Issued in NY
Practice address
1045 James St Ste 100
Syracuse, NY 13203-2758
Phone
(585) 410-3370
NPI assigned
Jul 23, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F407118-01 NY Primary

Addresses

Primary practice location

1045 James St Ste 100
Syracuse, NY 13203-2758

Mailing address

1045 James St Ste 100
Syracuse, NY 13203-2758

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250917002342 NY Practitioner - Nurse Practitioner 8123522729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Liberty Resources IncGroup PAC ID 4486703352, 82 clinicians

Practice addresses (Care Compare)

175 N Winton Rd
Rochester, NY 14610-1936
Phone (585) 410-3370

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F407118-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Resources Inc. CurrentSince Sep 1, 2025 Accepting new patients
Liberty Resources, Inc. CurrentSince Sep 1, 2025 Accepting new patients
Liberty Resources Inc. Current Accepting new patients

Locations

175 N Winton Rd
Rochester, NY 14610
Phone (585) 288-9230

1045 James St
Ste 100
Syracuse, NY 13203
Phone (315) 425-1004

1045 James St
Syracuse, NY 13203
Phone (315) 425-1004

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1174405740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032758",
            "telephone_number": "585-410-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDA",
        "first_name": "ALICIA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-23",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F407118-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.