Healthcare Provider Details

I. General information

NPI: 1790947430
Provider Name (Legal Business Name): SOFIA SHAHEEN CHAUDHARY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE EMORY UNIVERSITY, DEPARTMENT OF PEDIATRICS
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

3401 CIVIC CENTER BOULEVARD DIVISION PEDIATRIC EMERGENCY MEDICINE
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1440
  • Fax:
Mailing address:
  • Phone: 215-590-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMT213214
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: