Healthcare Provider Details

I. General information

NPI: 1194836676
Provider Name (Legal Business Name): SHEHZAD HAFIZ CHOUDRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

IV. Provider business mailing address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1570
  • Fax: 321-841-1569
Mailing address:
  • Phone: 321-841-1570
  • Fax: 321-841-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number200501013
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2005-01013
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberME141780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: