Healthcare Provider Details

I. General information

NPI: 1083147136
Provider Name (Legal Business Name): SHAOLI CHAUDHURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST STE 849
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4598
  • Fax: 305-243-4037
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number304131
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME168949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: