Healthcare Provider Details

I. General information

NPI: 1982649463
Provider Name (Legal Business Name): SHAHINA CHAUDRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61700 ROUTE 48
GREENPORT NY
11944-2206
US

IV. Provider business mailing address

1 OLD COUNTRY RD SUITE 271
CARLE PLACE NY
11514-1801
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-2110
  • Fax:
Mailing address:
  • Phone: 800-725-6280
  • Fax: 800-725-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR048958-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: