Healthcare Provider Details

I. General information

NPI: 1801359971
Provider Name (Legal Business Name): DIYA CHAKRABORTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE STE 7F
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD STE 2040
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 572-244-0041
  • Fax: 572-244-9942
Mailing address:
  • Phone: 405-271-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number47311
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: