Healthcare Provider Details

I. General information

NPI: 1205337920
Provider Name (Legal Business Name): VARDA CHIOCLEA SHOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MORDECHAI MAYER ST.
TEL AVIV ISRAEL
6964138
IL

IV. Provider business mailing address

8 MORDECHAI MAYER ST.
TEL AVIV ISRAEL
6964138
IL

V. Phone/Fax

Practice location:
  • Phone: 972-364-7602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21123
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: