Healthcare Provider Details

I. General information

NPI: 1245392562
Provider Name (Legal Business Name): SHAFI K CHOUDHURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

14 STONEY HOLLOW RD
CHAPPAQUA NY
10514-2014
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5800
  • Fax:
Mailing address:
  • Phone: 914-238-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNY153350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: