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General NPI Number Information
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NPI Number | 1477930949
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Entity Type | Individual
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Provider Name | AVINASH MIRLE CHANDRASHEKAR
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Gender | Male
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 5725 DARBREAK DR, APT C
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City | EASTVALE
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State | CA
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Zip | 91752
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Country | US
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Telephone | 209-322-6092
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Fax |
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Provider Business Mailing Address
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Address Line | 5725 DAYBREAK DR APT C
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City | EASTVALE
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State | CA
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Zip | 91752-6687
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Country | US
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Telephone | 209-322-6092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP 22570
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License Number State | CA
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