Healthcare Provider Details

I. General information

NPI: 1548584071
Provider Name (Legal Business Name): SANJEEV CHATURVEDI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 E PARK ROW DR
ARLINGTON TX
76010-4508
US

IV. Provider business mailing address

222 W. LAS COLINAS BLVD SUITE 2000
IRVING TX
75039
US

V. Phone/Fax

Practice location:
  • Phone: 817-522-0221
  • Fax: 817-522-0401
Mailing address:
  • Phone: 972-957-3000
  • Fax: 817-522-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: