=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447508783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SADIA RAHMAN CHAUDHURY PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2012
-----------------------------------------------------
Last Update Date | 02/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 WILLIS AVE FL 1
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-4408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-433-5382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 WILLIS AVE # 1
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-4408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-433-5382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 68019690
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------