Healthcare Provider Details

I. General information

NPI: 1174719975
Provider Name (Legal Business Name): SHABNAM CHAUGLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MEMORIAL ST., STE 3
PROSSER WA
99350
US

IV. Provider business mailing address

723 MEMORIAL ST
PROSSER WA
99350
US

V. Phone/Fax

Practice location:
  • Phone: 509-786-5599
  • Fax: 209-342-3743
Mailing address:
  • Phone: 509-786-2222
  • Fax: 509-786-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA101176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: