Healthcare Provider Details

I. General information

NPI: 1740097567
Provider Name (Legal Business Name): AJAY CHAWLA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 AUBURN AVE STE 2
SHELBY OH
44875-1171
US

IV. Provider business mailing address

110 AUBURN AVE STE 2
SHELBY OH
44875-1171
US

V. Phone/Fax

Practice location:
  • Phone: 419-342-4242
  • Fax: 419-347-1873
Mailing address:
  • Phone: 419-342-4242
  • Fax: 419-347-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AJAY CHAWLA
Title or Position: OWNER
Credential: MD
Phone: 419-342-4242