Healthcare Provider Details

I. General information

NPI: 1548879877
Provider Name (Legal Business Name): SANJAY CHAUDHURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 OLIVER RD # H
MONROE LA
71201-5702
US

IV. Provider business mailing address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 318-807-6258
  • Fax: 318-812-7347
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number342970
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: