Healthcare Provider Details

I. General information

NPI: 1295770063
Provider Name (Legal Business Name): SANGHAMITRA MISHRA CHOWDHURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N ELAM AVE STE 301
GREENSBORO NC
27403-1142
US

IV. Provider business mailing address

4747 N 7TH ST STE 100
PHOENIX AZ
85014-3654
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-9800
  • Fax: 336-832-1369
Mailing address:
  • Phone: 602-279-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101234226
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2019-01356
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2019-01356
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number36464
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: